Provider Demographics
NPI:1770056178
Name:NAGEL, GREGORY EDWARD (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:EDWARD
Last Name:NAGEL
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:EDWARD
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPRP
Mailing Address - Street 1:4460 S HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4460 S HIGHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-433-7739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator