Provider Demographics
NPI:1255501540
Name:MAGLIONE, MINDY R (NP)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:R
Last Name:MAGLIONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:ELLEN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2032 S 17TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6678
Mailing Address - Country:US
Mailing Address - Phone:910-763-3738
Mailing Address - Fax:910-763-0454
Practice Address - Street 1:2032 S 17TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6678
Practice Address - Country:US
Practice Address - Phone:910-763-3738
Practice Address - Fax:910-763-0454
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003915363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2593217Medicare PIN