Provider Demographics
NPI:1083948921
Name:MAGEE, TYNETTA (SA-C)
Entity Type:Individual
Prefix:
First Name:TYNETTA
Middle Name:
Last Name:MAGEE
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:TYNETTA
Other - Middle Name:
Other - Last Name:MAGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SA-C
Mailing Address - Street 1:3770 W 91ST CT
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5935
Mailing Address - Country:US
Mailing Address - Phone:219-973-3844
Mailing Address - Fax:
Practice Address - Street 1:15 FORESTDALE PARK
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5308
Practice Address - Country:US
Practice Address - Phone:708-487-6556
Practice Address - Fax:708-933-3470
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09-270246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant