Healthcare Provider Details

I. General information

NPI: 1376880997
Provider Name (Legal Business Name): LAURA MAE MAGOFFIE RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W CAREFREE HWY STE 124
PHOENIX AZ
85085-6095
US

IV. Provider business mailing address

39506 N DAISY MOUNTAIN DR STE 122169
ANTHEM AZ
85086-6068
US

V. Phone/Fax

Practice location:
  • Phone: 623-748-9106
  • Fax: 602-429-8579
Mailing address:
  • Phone: 623-748-9106
  • Fax: 602-429-8579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4802
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: