Individual
JENNIFER KAY MAGNUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
(317) 838-4751
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01089435A
IN
207P00000X
Emergency Medicine Physician
65773
AZ
207P00000X
Emergency Medicine Physician
R77317
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430H90
MEDICARE PTAN
IN
05
—
300080161
—
IN
Enumeration date
04/15/2019
Last updated
12/29/2023
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