Provider Demographics
NPI:1265757546
Name:NAGLE, MAUREEN MARY (LN)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MARY
Last Name:NAGLE
Suffix:
Gender:F
Credentials:LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 KNOX AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1502
Mailing Address - Country:US
Mailing Address - Phone:612-963-3229
Mailing Address - Fax:
Practice Address - Street 1:8200 HUMBOLDT AVE S
Practice Address - Street 2:SUITE 301
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1433
Practice Address - Country:US
Practice Address - Phone:612-963-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNN193133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education