MEDICARE: ORDELIS MONTEJO MAGANA APRN-CNP

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	163W00000X	Registered Nurse	1045294	TX
2	163WA2000X	Administrator Registered Nurse	1045294	TX
3	163WH0200X	Home Health Registered Nurse	1045294	TX
4	163WI0500X	Infusion Therapy Registered Nurse	1045294	TX
5	364SF0001X	Family Health Clinical Nurse Specialist	APRN11040684	TX

General Provider Information

NPI Number	:	1386508455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORDELIS MONTEJO MAGANA APRN-CNP

Provider Business Mailing Address
First Line	:	5803 SHADY HILL LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-2124
Country	:	US
Telephone Number	:	682-213-0816
Fax Number	:

Provider Business Practice Location Address
First Line	:	5803 SHADY HILL LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-2124
Country	:	US
Telephone Number	:	682-213-0816
Fax Number	:

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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