Provider Demographics
NPI:1023778024
Name:MAGOUN, NOARIE IVERIE (DNP)
Entity type:Individual
Prefix:
First Name:NOARIE
Middle Name:IVERIE
Last Name:MAGOUN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:NOARIE
Other - Middle Name:IVERIE
Other - Last Name:CARABALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12677 HESPERIA RD STE 130
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7735
Mailing Address - Country:US
Mailing Address - Phone:760-241-7763
Mailing Address - Fax:760-241-6383
Practice Address - Street 1:12677 HESPERIA RD STE 130
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7735
Practice Address - Country:US
Practice Address - Phone:760-241-7763
Practice Address - Fax:760-241-6383
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-19
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019412363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty