Provider Demographics
NPI:1801532163
Name:MAGINNIS, KRISTIN GOBER
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:GOBER
Last Name:MAGINNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 MASSENA ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4895
Mailing Address - Country:US
Mailing Address - Phone:985-626-3950
Mailing Address - Fax:985-674-0886
Practice Address - Street 1:519 MASSENA ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4895
Practice Address - Country:US
Practice Address - Phone:985-626-3950
Practice Address - Fax:985-674-0886
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN138699163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool