Provider Demographics
NPI:1548634207
Name:NAGEL, LAURA M (LMP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:NAGEL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 1095
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-1095
Mailing Address - Country:US
Mailing Address - Phone:360-969-1592
Mailing Address - Fax:360-279-9951
Practice Address - Street 1:12885 CASINO DR
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-8363
Practice Address - Country:US
Practice Address - Phone:360-969-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60553697171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor