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Individual
KELLY MAGRUM
Active
Individual
KELLY MAGRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
ND
172A00000X
Driver
—
NULL
174400000X
Specialist
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1482572
—
ND
Enumeration date
06/15/2021
Last updated
09/09/2021
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