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NPI Code Detail

MEDICARE: KATHLEEN MARIE MAGNIN A.N.P.

MEDICARE: KATHLEEN MARIE MAGNIN A.N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner1315033WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306821517
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN MARIE MAGNIN A.N.P.
Provider Business Mailing Address
First Line : PO BOX 28900
Second Line :
City : GREEN BAY
State : WI
Zip : 54324-0900
Country : US
Telephone Number : 920-490-9046
Fax Number : 920-405-5388
Provider Business Practice Location Address
First Line : 3003 UNIVERSITY DR
Second Line :
City : MARINETTE
State : WI
Zip : 54143-4110
Country : US
Telephone Number : 715-735-3187
Fax Number : 715-735-5848
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2005
Last Update Date : 04/10/2024

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