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General NPI Number Information
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NPI Number | 1639403041
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Entity Type | Individual
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Provider Name | STEFANIE JEAN MAGEE PA
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Gender | Female
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 141 CITATION WAY UNIT 2
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City | HAILEY
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State | ID
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Zip | 83333-5104
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Country | US
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Telephone | 208-684-0684
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3721
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City | HAILEY
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State | ID
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Zip | 83333-3721
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Country | US
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Telephone | 208-309-3221
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA-820
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-820
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12409905-1206
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License Number State | UT
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