Provider Demographics
NPI:1467233791
Name:NAGEL, AUSTIN GLEN
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:GLEN
Last Name:NAGEL
Suffix:
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 1:625 18TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3528
Mailing Address - Country:US
Mailing Address - Phone:701-509-2908
Mailing Address - Fax:
Practice Address - Street 1:430 OXFORD ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-6092
Practice Address - Country:US
Practice Address - Phone:701-777-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program