MEDICARE: NICOLE NAGLE CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704298292	MI
2	367500000X	Certified Registered Nurse Anesthetist	4704298292	MI

General Provider Information

NPI Number	:	1033871330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE NAGLE CRNA

Provider Business Mailing Address
First Line	:	3314 MILLICENT AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1354
Country	:	US
Telephone Number	:	248-255-1666
Fax Number	:

Provider Business Practice Location Address
First Line	:	3314 MILLICENT AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1354
Country	:	US
Telephone Number	:	248-255-1666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2021
Last Update Date	:	02/08/2023

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