Healthcare Provider Details

I. General information

NPI: 1881185130
Provider Name (Legal Business Name): ANNA M MAGURA CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 ROBINWOOD DR
NEW MIDDLETOWN OH
44442-9721
US

IV. Provider business mailing address

132 ROBINWOOD DR
NEW MIDDLETOWN OH
44442-9721
US

V. Phone/Fax

Practice location:
  • Phone: 330-921-9577
  • Fax:
Mailing address:
  • Phone: 330-921-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA167001
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: