Provider Demographics
NPI:1801633896
Name:ACKERS, MAGDALINE (FNP)
Entity type:Individual
Prefix:
First Name:MAGDALINE
Middle Name:
Last Name:ACKERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAGDALINE
Other - Middle Name:
Other - Last Name:KANIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:100 CROSSING BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5555
Mailing Address - Country:US
Mailing Address - Phone:857-255-3315
Mailing Address - Fax:
Practice Address - Street 1:101 CENTERPOINT DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-7568
Practice Address - Country:US
Practice Address - Phone:857-255-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT135082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily