Provider Demographics
NPI:1952385734
Name:NAEGELE, LISA M (CFNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:NAEGELE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBOURNE
Mailing Address - State:WV
Mailing Address - Zip Code:26149-9622
Mailing Address - Country:US
Mailing Address - Phone:304-233-9314
Mailing Address - Fax:
Practice Address - Street 1:100 FAIR AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBOURNE
Practice Address - State:WV
Practice Address - Zip Code:26149-9622
Practice Address - Country:US
Practice Address - Phone:304-758-5111
Practice Address - Fax:304-758-4646
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q01463Medicare UPIN