=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255157772
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERELYNN-GAY ASUNCION MAGSANO PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2024
-----------------------------------------------------
Last Update Date | 11/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 W COMBS RD STE 101-277
-----------------------------------------------------
City | SAN TAN VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85140-9126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-299-7873
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 85 W COMBS RD STE 101
-----------------------------------------------------
City | SAN TAN VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85140-9106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-299-7873
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 315615
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------