Provider Demographics
NPI:1962433144
Name:MUDD, MAGDALENE FINAN (NP)
Entity type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:FINAN
Last Name:MUDD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:910-235-3443
Practice Address - Street 1:205 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8798
Practice Address - Country:US
Practice Address - Phone:910-295-5511
Practice Address - Fax:910-235-3432
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201906363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0987OtherSC MEDICAID PROVIDER#
NC7003655Medicaid
NCP00300187OtherPALMETTO GOVT SERVICES
NCFH4000450OtherFIRSTCAROLINACARE PROV.#
NCD9093OtherMEDCOST PROVIDER#
NCP00300187OtherPALMETTO GOVT SERVICES
NCD9093OtherMEDCOST PROVIDER#