MEDICARE: MS. MARCIA MAGANN NP

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	363LP0200X	Pediatric Nurse Practitioner	0024146630	VA

General Provider Information

NPI Number	:	1982684171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA MAGANN NP

Provider Business Mailing Address
First Line	:	1 CHILDRENS WAY
Second Line	:	SLOT# 653
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-3500
Country	:	US
Telephone Number	:	501-614-2125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CHILDRENS WAY
Second Line	:	SLOT# 653
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-3500
Country	:	US
Telephone Number	:	501-614-2125
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	05/20/2010

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