Provider Demographics
NPI:1659562742
Name:MAGOFFIN, MARILYN SUE (FNP, CWCN)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:SUE
Last Name:MAGOFFIN
Suffix:
Gender:F
Credentials:FNP, CWCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:COVELO
Mailing Address - State:CA
Mailing Address - Zip Code:95428-0247
Mailing Address - Country:US
Mailing Address - Phone:707-983-6181
Mailing Address - Fax:707-983-6802
Practice Address - Street 1:24065 BIGGAR LANE
Practice Address - Street 2:
Practice Address - City:COVELO
Practice Address - State:CA
Practice Address - Zip Code:95428-0247
Practice Address - Country:US
Practice Address - Phone:707-983-6181
Practice Address - Fax:707-983-6802
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17406363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner