Provider Demographics
NPI:1740528488
Name:MAGRUDER, NATHAN Z (LAC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:Z
Last Name:MAGRUDER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2944 S FERN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-2426
Mailing Address - Country:US
Mailing Address - Phone:316-218-7734
Mailing Address - Fax:316-558-3067
Practice Address - Street 1:2944 S FERN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-2426
Practice Address - Country:US
Practice Address - Phone:316-218-7734
Practice Address - Fax:316-558-3067
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS852101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)