Healthcare Provider Details

I. General information

NPI: 1467406066
Provider Name (Legal Business Name): APRIL B. MAGNUSSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-5131
  • Fax: 740-446-5486
Mailing address:
  • Phone: 740-446-5131
  • Fax: 740-446-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-03-7590
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: