Provider Demographics
NPI:1164092201
Name:MAGEE, MONICA ROSHAIL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ROSHAIL
Last Name:MAGEE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 SANDERS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-9016
Mailing Address - Country:US
Mailing Address - Phone:160-441-5326
Mailing Address - Fax:
Practice Address - Street 1:111 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2825
Practice Address - Country:US
Practice Address - Phone:601-783-2374
Practice Address - Fax:601-783-5126
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS865518163W00000X
MS904622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse