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General NPI Number Information
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NPI Number | 1386127702
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Entity Type | Individual
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Provider Name | PATRICIA A MAGSBY
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Gender | Female
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 2119 E 223RD ST
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City | SAUK VILLAGE
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State | IL
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Zip | 60411-5030
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Country | US
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Telephone | 708-513-4243
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Fax |
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Provider Business Mailing Address
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Address Line | 2119 E 223RD ST
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City | SAUK VILLAGE
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State | IL
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Zip | 60411-5030
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Country | US
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Telephone | 708-513-4243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | H184554
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License Number State | IL
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