Provider Demographics
NPI:1407534498
Name:NAGEL, BAYLIE
Entity Type:Individual
Prefix:
First Name:BAYLIE
Middle Name:
Last Name:NAGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:ND
Mailing Address - Zip Code:58785-7147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 2ND ST NE
Practice Address - Street 2:
Practice Address - City:SURREY
Practice Address - State:ND
Practice Address - Zip Code:58785-7147
Practice Address - Country:US
Practice Address - Phone:701-640-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR47198367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered