Provider Demographics
NPI:1811759681
Name:IMUZE, MAGDALENE OFURE
Entity type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:OFURE
Last Name:IMUZE
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 1:11 E BROOK HILL CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4404
Mailing Address - Country:US
Mailing Address - Phone:443-713-9869
Mailing Address - Fax:
Practice Address - Street 1:11 E BROOK HILL CT
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4404
Practice Address - Country:US
Practice Address - Phone:443-713-9869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR245603363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health