Provider Demographics
NPI:1255045910
Name:MAGNUSON, ZACHARY JAMES
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JAMES
Last Name:MAGNUSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 17TH ST NE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-2737
Mailing Address - Country:US
Mailing Address - Phone:701-307-0402
Mailing Address - Fax:
Practice Address - Street 1:814 17TH ST NE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2737
Practice Address - Country:US
Practice Address - Phone:701-307-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator