Individual
MR. NILS PAUL MAGNUSSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C PMHNP-BC
Contact information
Practice address
43 SERVIDEA DR, RIDGWAY, PA 15853-6333
(814) 776-2145
(814) 776-1470
Mailing address
43 SERVIDEA DR, RIDGWAY, PA 15853-6333
(814) 776-2145
(814) 776-1470
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN639375
PA
363LF0000X
Family Nurse Practitioner
SP018242
PA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP023043
PA
Other
Enumeration date
08/28/2017
Last updated
07/21/2022
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