Provider Demographics
NPI:1841402351
Name:MAGG, DENISE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:MAGG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 280TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-7373
Mailing Address - Country:US
Mailing Address - Phone:712-336-4875
Mailing Address - Fax:712-336-4875
Practice Address - Street 1:1728 280TH AVE
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-7373
Practice Address - Country:US
Practice Address - Phone:712-336-4875
Practice Address - Fax:712-336-4875
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA062348163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse