MEDICARE: MRS. THERESA M NAGEL RN

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	163WM0102X	Maternal Newborn Registered Nurse		WI

General Provider Information

NPI Number	:	1780854158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THERESA M NAGEL RN

Provider Business Mailing Address
First Line	:	2151 COLONIAL WAY
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-8838
Country	:	US
Telephone Number	:	360-682-5097
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 COLONIAL WAY
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-8838
Country	:	US
Telephone Number	:	360-682-5097
Fax Number	:

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

Provider Enumeration Date	:	03/02/2008
Last Update Date	:	03/02/2008

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