Healthcare Provider Details

I. General information

NPI: 1457173965
Provider Name (Legal Business Name): VALERIA MAGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 NEBRASKA ST
SIOUX CITY IA
51105-1436
US

IV. Provider business mailing address

3123 S CYPRESS ST
SIOUX CITY IA
51106-4216
US

V. Phone/Fax

Practice location:
  • Phone: 712-252-2477
  • Fax:
Mailing address:
  • Phone: 712-444-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA181316
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: