MEDICARE: AUSTIN GLEN NAGEL

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1467233791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN GLEN NAGEL

Provider Business Mailing Address
First Line	:	625 18TH ST SW
Second Line	:
City	:	MINOT
State	:	ND
Zip	:	58701-3528
Country	:	US
Telephone Number	:	701-509-2908
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 OXFORD ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58202-6092
Country	:	US
Telephone Number	:	701-777-4174
Fax Number	:

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

Provider Enumeration Date	:	10/12/2023
Last Update Date	:	10/12/2023

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Directions to “ AUSTIN GLEN NAGEL ” Practice Location

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