Basic Information
| Provider Information | |||||||||
| NPI: | 1306826292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAGER | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 W MAPLE ST | ||||||||
| Address2: | STE. 110 | ||||||||
| City: | HARTVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446329668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308773616 | ||||||||
| FaxNumber: | 3308771783 | ||||||||
| Practice Location | |||||||||
| Address1: | 855 W MAPLE ST | ||||||||
| Address2: | STE. 110 | ||||||||
| City: | HARTVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446329668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308773616 | ||||||||
| FaxNumber: | 3308771783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | NP05762 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 2260646 | 05 | OH | MEDICAID |