Provider Demographics
NPI:1326786583
Name:WAEGELE, DANIEL LEWIS JR
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEWIS
Last Name:WAEGELE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:KENO
Mailing Address - State:OR
Mailing Address - Zip Code:97627-0902
Mailing Address - Country:US
Mailing Address - Phone:541-810-1166
Mailing Address - Fax:
Practice Address - Street 1:2225 N. EL DORADO AVENUE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6174
Practice Address - Country:US
Practice Address - Phone:541-273-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201243682163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management