MEDICARE: MAGIC M. ALLEN AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	209015500	IL

General Provider Information

NPI Number	:	1376080630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGIC M. ALLEN AGACNP-BC

Provider Business Mailing Address
First Line	:	700 E OGDEN AVE STE 202
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-1398
Country	:	US
Telephone Number	:	630-789-9785
Fax Number	:	630-789-9798

Provider Business Practice Location Address
First Line	:	700 E OGDEN AVE STE 202
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-1398
Country	:	US
Telephone Number	:	630-789-9785
Fax Number	:	630-789-9798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	11/21/2018

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