Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP60585215 | WA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | G156946 | IA |
NPI | 1013115757 |
---|---|
Provider Name | Dianna Kay Magginetti |
First Address | Waterloo, IA 50703-4407 |
Second Address | Waterloo, IA 50703-4407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 30/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013115757 | (05) | WA |
P01540043 | RR PTAN (01) | WA |