Provider Demographics
NPI:1235885146
Name:MAGEE, MIRANDA FITZGERALD (APRN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:FITZGERALD
Last Name:MAGEE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3843
Mailing Address - Country:US
Mailing Address - Phone:864-943-4279
Mailing Address - Fax:864-223-2642
Practice Address - Street 1:210 WELLS AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3843
Practice Address - Country:US
Practice Address - Phone:864-943-4279
Practice Address - Fax:864-223-2642
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily