Provider Demographics
NPI:1437263860
Name:DOUGAL, JAMES HAROLD (RN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HAROLD
Last Name:DOUGAL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9701 BRUSH COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46797-9770
Mailing Address - Country:US
Mailing Address - Phone:260-657-5663
Mailing Address - Fax:
Practice Address - Street 1:3840 NEW VISION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1708
Practice Address - Country:US
Practice Address - Phone:260-483-2422
Practice Address - Fax:260-471-0788
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28068712A163W00000X
IN0242619146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic