MEDICARE: TERESA MAGANA FNP

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	363LF0000X	Family Nurse Practitioner	11924	CA
2	363LP2300X	Primary Care Nurse Practitioner	11924	CA

General Provider Information

NPI Number	:	1891884334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA MAGANA FNP

Provider Business Mailing Address
First Line	:	PO BOX 1434
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95241-1434
Country	:	US
Telephone Number	:	209-462-7277
Fax Number	:	866-950-0134

Provider Business Practice Location Address
First Line	:	1503 E MARCH LN STE A
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95210-5622
Country	:	US
Telephone Number	:	209-462-7277
Fax Number	:	866-950-0134

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	03/28/2022

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