Provider Demographics
NPI:1194157768
Name:NAGEL, CHARLENE MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:NAGEL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ELYRIA ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1031
Mailing Address - Country:US
Mailing Address - Phone:330-948-9939
Mailing Address - Fax:330-948-2263
Practice Address - Street 1:225 ELYRIA ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-1031
Practice Address - Country:US
Practice Address - Phone:330-948-9939
Practice Address - Fax:330-948-2263
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14785-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1801807870OtherLODI COMMUNITY HOSPITAL TYPE 2 NPI #
OH0089483Medicaid
OH3613031OtherLODI COMMUNITY HOSPITAL MEDICARE GROUP #
OH1003849910OtherLODI COMMUNITY CARE CENTER TYPE 2 NPI #
OH2396081OtherLODI COMMUNITY HOSPITAL GROUP MEDICAID #
OH0089483Medicaid