Healthcare Provider Details

I. General information

NPI: 1225168198
Provider Name (Legal Business Name): SANNE JONES MAGNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CEDAR ST
SAINT PAUL MN
55101-2209
US

IV. Provider business mailing address

1022 26TH AVE SE
MINNEAPOLIS MN
55414-2642
US

V. Phone/Fax

Practice location:
  • Phone: 651-266-1343
  • Fax:
Mailing address:
  • Phone: 952-814-7075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29770
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: