Provider Demographics
NPI:1528393675
Name:MAGYAR, JESSICA M (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:MAGYAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 E CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2041
Mailing Address - Country:US
Mailing Address - Phone:517-279-5437
Mailing Address - Fax:517-279-5366
Practice Address - Street 1:274 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2041
Practice Address - Country:US
Practice Address - Phone:517-279-5437
Practice Address - Fax:517-279-5366
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104955363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant