Healthcare Provider Details

I. General information

NPI: 1982682373
Provider Name (Legal Business Name): MICHELLE MARIE MAGDSICK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 STATE HYW 7
EXCELSIOR MN
55331
US

IV. Provider business mailing address

1526 CLOUD DR NE
BLAINE MN
55449-4731
US

V. Phone/Fax

Practice location:
  • Phone: 952-446-9222
  • Fax: 952-446-9225
Mailing address:
  • Phone: 763-754-8202
  • Fax: 763-754-3806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number070733-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: