1710103791 NPI number — JAYME LEE NAGLE P.T.

Table of content: JAYME LEE NAGLE P.T. (NPI 1710103791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710103791 NPI number — JAYME LEE NAGLE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAGLE
Provider First Name:
JAYME
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLSEN
Provider Other First Name:
JAYME
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710103791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 MDG
Provider Second Line Business Mailing Address:
UNIT 2060
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96278 2060
Provider Business Mailing Address Country Code:
KR
Provider Business Mailing Address Telephone Number:
01182316618717
Provider Business Mailing Address Fax Number:
01182316613625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 MDG
Provider Second Line Business Practice Location Address:
UNIT 2060
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96278 2060
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
01182316618717
Provider Business Practice Location Address Fax Number:
01182316613625
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  7245 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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