Provider Demographics
NPI:1952077224
Name:MAGDA, LUCY SEAGRAVES
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:SEAGRAVES
Last Name:MAGDA
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 1:2300 REXWOODS DR STE 140
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3361
Mailing Address - Country:US
Mailing Address - Phone:704-360-3637
Mailing Address - Fax:704-323-5710
Practice Address - Street 1:2300 REXWOODS DR STE 140
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3361
Practice Address - Country:US
Practice Address - Phone:704-360-3637
Practice Address - Fax:704-323-5710
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN238495163W00000X
NC5016653363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner