Provider Demographics
NPI:1093570202
Name:JAGIELKA-CANABE, MAGDALENA (PMHNP-BC, APN-BC)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:JAGIELKA-CANABE
Suffix:
Gender:F
Credentials:PMHNP-BC, APN-BC
Other - Prefix:
Other - First Name:MAGDALENA
Other - Middle Name:
Other - Last Name:JAGIELKA-CANABE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC, APN-BC
Mailing Address - Street 1:5 REGENT ST BLDG 5S
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1675
Mailing Address - Country:US
Mailing Address - Phone:855-436-7792
Mailing Address - Fax:
Practice Address - Street 1:5 REGENT ST BLDG 5S
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1675
Practice Address - Country:US
Practice Address - Phone:855-436-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14986000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health