Provider Demographics
NPI:1104213123
Name:NAGEL, MARC T (PA-C)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:T
Last Name:NAGEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-955-6522
Mailing Address - Fax:208-955-6503
Practice Address - Street 1:3115 E FLORENCE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1586
Practice Address - Country:US
Practice Address - Phone:208-895-8670
Practice Address - Fax:208-955-0494
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-1248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant