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General NPI Number Information
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NPI Number | 1194582924
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Entity Type | Organization
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Legal Business Name | NAGEL NEIGHBORHOOD HEALTH LLC
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 612 MARY KNOLL LN
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City | WATERTOWN
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State | WI
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Zip | 53098-1216
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Country | US
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Telephone | 920-631-1310
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Fax | 920-335-3570
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Provider Business Mailing Address
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Address Line | 612 MARY KNOLL LN
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City | WATERTOWN
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State | WI
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Zip | 53098-1216
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Country | US
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Telephone | 920-631-1310
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Fax | 920-335-3570
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Authorized Official
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Title or Position | PRESIDENT
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Name | LINNEA NAGEL
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Credential | PA-C
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Telephone | 920-631-1310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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