Healthcare Provider Details

I. General information

NPI: 1063950491
Provider Name (Legal Business Name): CASEY AMANDA MCGINNIS DNP, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE BOX 555191 NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

200 MERCY CIRCLE BOX 555191 NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3675
  • Fax:
Mailing address:
  • Phone: 760-719-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95004739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: