Provider Demographics
NPI:1467641902
Name:MAGEE, JOANNA SUE
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:SUE
Last Name:MAGEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3127
Mailing Address - Country:US
Mailing Address - Phone:504-347-5435
Mailing Address - Fax:504-349-2119
Practice Address - Street 1:1255 AVENUE D
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3127
Practice Address - Country:US
Practice Address - Phone:504-347-5435
Practice Address - Fax:504-349-2119
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03144203165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1546232Medicaid
LA1546232Medicaid
LA5X719Medicare PIN