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General NPI Number Information
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NPI Number | 1902433477
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Entity Type | Individual
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Provider Name | CHRISTINA NAGLE
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 200 THEDA CLARK MEDICAL PLZ
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City | NEENAH
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State | WI
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Zip | 54956-2721
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Country | US
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Telephone | 920-358-1223
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Fax | 920-358-1224
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Provider Business Mailing Address
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Address Line | 3101 WHITING AVE APT C4
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City | STEVENS POINT
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State | WI
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Zip | 54481-5133
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5241
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License Number State | WI
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