Healthcare Provider Details

I. General information

NPI: 1770052722
Provider Name (Legal Business Name): MAGDALENA KASSUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 PIERCE DR
COLUMBUS OH
43223-2425
US

IV. Provider business mailing address

765 PIERCE DR
COLUMBUS OH
43223-2425
US

V. Phone/Fax

Practice location:
  • Phone: 614-233-1650
  • Fax: 888-679-9808
Mailing address:
  • Phone: 614-233-1650
  • Fax: 888-679-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number378853
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: