MEDICARE: ANGELA MARIE GAGER CNP

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	363LA2200X	Adult Health Nurse Practitioner	NP05762	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306826292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE GAGER CNP

Provider Business Mailing Address
First Line	:	855 W MAPLE ST
Second Line	:	STE. 110
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9668
Country	:	US
Telephone Number	:	330-877-3616
Fax Number	:	330-877-1783

Provider Business Practice Location Address
First Line	:	855 W MAPLE ST
Second Line	:	STE. 110
City	:	HARTVILLE
State	:	OH
Zip	:	44632-9668
Country	:	US
Telephone Number	:	330-877-3616
Fax Number	:	330-877-1783

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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