MEDICARE: SUSAN L MAGADAN PA-C

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	363A00000X	Physician Assistant	5548	AZ
2	363A00000X	Physician Assistant	4103	WI
3	363A00000X	Physician Assistant	PA03559	TX
4	363L00000X	Nurse Practitioner	PA1953	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA1953	OTHER	NV	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508929969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L MAGADAN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 98978
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8978
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:	702-671-6883

Provider Business Practice Location Address
First Line	:	8285 W ARBY AVE STE 100B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2235
Country	:	US
Telephone Number	:	702-735-7154
Fax Number	:	702-405-1860

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	04/23/2018

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Directions to “ SUSAN L MAGADAN PA-C” Practice Location

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