Healthcare Provider Details

I. General information

NPI: 1063342343
Provider Name (Legal Business Name): MAGGIN WEBB NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 N 17TH ST
LAFAYETTE IN
47904-1409
US

IV. Provider business mailing address

2016 N 17TH ST
LAFAYETTE IN
47904-1409
US

V. Phone/Fax

Practice location:
  • Phone: 708-275-1634
  • Fax:
Mailing address:
  • Phone: 708-275-1634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number28248676A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: