Provider Demographics
NPI:1700322245
Name:MAGNUSON, LEAH JEAN (NP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:JEAN
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:JEAN
Other - Last Name:APPLEBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:316 NORTHWEST XING
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9252
Mailing Address - Country:US
Mailing Address - Phone:616-780-8663
Mailing Address - Fax:
Practice Address - Street 1:1131 IONIA AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1020
Practice Address - Country:US
Practice Address - Phone:616-259-7900
Practice Address - Fax:616-259-7909
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297314163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse