Healthcare Provider Details

I. General information

NPI: 1982962189
Provider Name (Legal Business Name): MS. DIANE MELYNNE MAGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 MAYLAWN AVE
WADSWORTH OH
44281-1262
US

IV. Provider business mailing address

274 MAYLAWN AVE
WADSWORTH OH
44281-1262
US

V. Phone/Fax

Practice location:
  • Phone: 330-606-8839
  • Fax:
Mailing address:
  • Phone: 330-606-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: