Healthcare Provider Details

I. General information

NPI: 1417304338
Provider Name (Legal Business Name): ASHLEY MAGEE NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 S ELLSWORTH RD STE 109
MESA AZ
85212-2165
US

IV. Provider business mailing address

2919 S ELLSWORTH RD STE 109
MESA AZ
85212-2165
US

V. Phone/Fax

Practice location:
  • Phone: 480-357-5555
  • Fax: 480-357-0011
Mailing address:
  • Phone: 480-357-5555
  • Fax: 480-357-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number16-1544
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16-1544
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: