Provider Demographics
NPI:1053843805
Name:MAGEE, JEAN E
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:MAGEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 CANTON LN
Mailing Address - Street 2:
Mailing Address - City:STUARTS DRAFT
Mailing Address - State:VA
Mailing Address - Zip Code:24477-2523
Mailing Address - Country:US
Mailing Address - Phone:540-213-2537
Mailing Address - Fax:
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:H AND V GROUND FLOOR
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-213-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA124Q00000X
174H00000X
VA21700761133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No124Q00000XDental ProvidersDental Hygienist
No174H00000XOther Service ProvidersHealth Educator