Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | CNP3754 | MN |
NPI | 1003201138 |
---|---|
Provider Name | Deborah Magnuson |
First Address | Mendota Heights, MN 55118-1944 |
Second Address | Minneapolis, MN 55404-4518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2015 |
Last Update Date | 14/05/2021 |