Healthcare Provider Details

I. General information

NPI: 1700156528
Provider Name (Legal Business Name): SHEA D. MAGILL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N HIGLEY RD
GILBERT AZ
85234-1604
US

IV. Provider business mailing address

PO BOX 29211
PHOENIX AZ
85038-9211
US

V. Phone/Fax

Practice location:
  • Phone: 602-273-6770
  • Fax: 602-889-0483
Mailing address:
  • Phone: 602-273-6770
  • Fax: 602-889-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN142961
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0831
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: