Provider Demographics
NPI:1245654532
Name:WARE, MAGENTA CYANN (LPN)
Entity type:Individual
Prefix:MISS
First Name:MAGENTA
Middle Name:CYANN
Last Name:WARE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:DR
Other - First Name:MAGENTA
Other - Middle Name:CYANN
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:36571 MARLER
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36571 MARLER ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1924
Practice Address - Country:US
Practice Address - Phone:313-768-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703112395164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse