Healthcare Provider Details

I. General information

NPI: 1922094515
Provider Name (Legal Business Name): BETH ETTA MAGEE-SIEFERT MSN APN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH ETTA MAGEE CPNP RNC

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 PERSIMMON ST
GLASSBORO NJ
08028-2840
US

IV. Provider business mailing address

124 PERSIMMON ST
GLASSBORO NJ
08028-2840
US

V. Phone/Fax

Practice location:
  • Phone: 856-256-9310
  • Fax:
Mailing address:
  • Phone: 856-256-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NN05957700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: