Provider Demographics
NPI:1306117437
Name:MAGEAU, DENISE P
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:P
Last Name:MAGEAU
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 1:7908 ESTERBROOK WAY
Mailing Address - Street 2:UNIT 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4180
Mailing Address - Country:US
Mailing Address - Phone:702-767-1197
Mailing Address - Fax:
Practice Address - Street 1:7908 ESTERBROOK WAY
Practice Address - Street 2:UNIT 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4180
Practice Address - Country:US
Practice Address - Phone:702-767-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker