Provider Demographics
NPI:1952872095
Name:NAGEL, AMANDA YVETTE (LPTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:YVETTE
Last Name:NAGEL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 O AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2187
Mailing Address - Country:US
Mailing Address - Phone:360-755-3399
Mailing Address - Fax:360-755-3399
Practice Address - Street 1:1300 O AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2187
Practice Address - Country:US
Practice Address - Phone:360-755-3399
Practice Address - Fax:360-755-3399
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160855285208100000X
WA608552852081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation