Provider Demographics
NPI:1134617541
Name:MAGEE, SUSAN RAE (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RAE
Last Name:MAGEE
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 1:4330 BULL CREEK RD APT 3316
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-5961
Mailing Address - Country:US
Mailing Address - Phone:512-791-2142
Mailing Address - Fax:
Practice Address - Street 1:4330 BULL CREEK RD APT 3316
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-5961
Practice Address - Country:US
Practice Address - Phone:512-791-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58554163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty