Healthcare Provider Details

I. General information

NPI: 1487041455
Provider Name (Legal Business Name): JESSIE ELIZABETH MAGNANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE ELIZABETH EVANGELISTA MD

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 W THOMAS RD STE 360
PHOENIX AZ
85037-3385
US

IV. Provider business mailing address

1661 E CAMELBACK RD STE 200
PHOENIX AZ
85016-3913
US

V. Phone/Fax

Practice location:
  • Phone: 602-635-6151
  • Fax: 623-215-3114
Mailing address:
  • Phone: 602-805-2669
  • Fax: 602-559-5641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number80816
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301115925
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: