1932461225 NPI number — MRS. MAGAN GOFF HENDERSON RN, APN

Table of content: MRS. MAGAN GOFF HENDERSON RN, APN (NPI 1932461225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932461225 NPI number — MRS. MAGAN GOFF HENDERSON RN, APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDERSON
Provider First Name:
MAGAN
Provider Middle Name:
GOFF
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOFF
Provider Other First Name:
MAGAN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, APN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932461225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1421 W BADDOUR PKWY
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37087-2652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-449-6780
Provider Business Mailing Address Fax Number:
615-449-1929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1421 W BADDOUR PKWY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37087-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-449-6780
Provider Business Practice Location Address Fax Number:
615-449-1929
Provider Enumeration Date:
06/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  APN0000014885 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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