Provider Demographics
NPI:1154647337
Name:MAGNO, MYLA AFABLE (MSN RN GNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:MYLA
Middle Name:AFABLE
Last Name:MAGNO
Suffix:
Gender:F
Credentials:MSN RN GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4356
Mailing Address - Street 2:DEPT 1610
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4356
Mailing Address - Country:US
Mailing Address - Phone:713-521-0006
Mailing Address - Fax:
Practice Address - Street 1:4660 BEECHNUT ST STE 218
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1825
Practice Address - Country:US
Practice Address - Phone:713-521-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX702414363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00924645OtherMEDICARE RAILROAD
TX215562401Medicaid
2609025OtherCIGNA
9114584OtherAETNA
SCP00924645OtherMEDICARE RAILROAD