Provider Demographics
NPI:1346767696
Name:MAGNUSSON, NILS PAUL (FNP-C PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:NILS
Middle Name:PAUL
Last Name:MAGNUSSON
Suffix:
Gender:M
Credentials:FNP-C PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SERVIDEA DR
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-6333
Mailing Address - Country:US
Mailing Address - Phone:814-776-2145
Mailing Address - Fax:814-776-1470
Practice Address - Street 1:43 SERVIDEA DR
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-6333
Practice Address - Country:US
Practice Address - Phone:814-776-2145
Practice Address - Fax:814-776-1470
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023043363LP0808X
PARN639375163W00000X
PASP018242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily