Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95019412 | CA |
NPI | 1023778024 |
---|---|
Provider Name | Noarie Iverie Magoun |
First Address | Victorville, CA 92395-8306 |
Second Address | Victorville, CA 92395-8306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2021 |
Last Update Date | 19/12/2021 |