Provider Demographics
NPI:1174343867
Name:PAGEL, CHARLENE MARIE (CNM)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:PAGEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:MARIE
Other - Last Name:REIERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1419 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-5603
Mailing Address - Country:US
Mailing Address - Phone:920-252-1678
Mailing Address - Fax:
Practice Address - Street 1:301 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1306
Practice Address - Country:US
Practice Address - Phone:920-574-3074
Practice Address - Fax:920-574-9502
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI150069-32367A00000X
WIL-162701174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN