Provider Demographics
NPI:1386639961
Name:HAGEL, CHARLA AIMEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHARLA
Middle Name:AIMEE
Last Name:HAGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHARLA
Other - Middle Name:AIMEE
Other - Last Name:SCHREINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1068 SUFFOLK CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5605
Mailing Address - Country:US
Mailing Address - Phone:847-856-8261
Mailing Address - Fax:
Practice Address - Street 1:1068 SUFFOLK CT
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5605
Practice Address - Country:US
Practice Address - Phone:847-856-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP64799Medicare UPIN