Provider Demographics
NPI:1780854158
Name:NAGEL, THERESA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:NAGEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:HENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2151 COLONIAL WAY
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-8838
Mailing Address - Country:US
Mailing Address - Phone:360-682-5097
Mailing Address - Fax:
Practice Address - Street 1:2151 COLONIAL WAY
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-8838
Practice Address - Country:US
Practice Address - Phone:360-682-5097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-02
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn