Healthcare Provider Details

I. General information

NPI: 1356358907
Provider Name (Legal Business Name): LUCINDA ANN MAGNESS CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E WATSON ST
ALBION MI
49224-1194
US

IV. Provider business mailing address

225 E WATSON ST
ALBION MI
49224-1194
US

V. Phone/Fax

Practice location:
  • Phone: 517-629-8464
  • Fax: 517-629-8466
Mailing address:
  • Phone: 517-629-8464
  • Fax: 517-629-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704149953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: