Provider Demographics
NPI:1881762441
Name:MAGTOTO, ROMANA G (APRN,BC)
Entity type:Individual
Prefix:
First Name:ROMANA
Middle Name:G
Last Name:MAGTOTO
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 S WILLETT ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4921
Mailing Address - Country:US
Mailing Address - Phone:901-278-1308
Mailing Address - Fax:
Practice Address - Street 1:6385 STAGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3738
Practice Address - Country:US
Practice Address - Phone:901-386-1683
Practice Address - Fax:901-385-8252
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005633363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics