Provider Demographics
NPI:1376235929
Name:MAGANA, MARIE ANTOINETTE (MSN-RN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ANTOINETTE
Last Name:MAGANA
Suffix:
Gender:F
Credentials:MSN-RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34517 WINSLOW TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3628
Mailing Address - Country:US
Mailing Address - Phone:630-618-8868
Mailing Address - Fax:
Practice Address - Street 1:34517 WINSLOW TER
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3628
Practice Address - Country:US
Practice Address - Phone:630-618-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025285363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health