MEDICARE: KRISTINA A ROST-MANGAN MS, RN, CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	COA 09945-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992976393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA A ROST-MANGAN MS, RN, CNP

Provider Business Mailing Address
First Line	:	2912 SPRINGBORO W
Second Line	:	SUITE 200
City	:	MORAINE
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8999
Fax Number	:	937-298-9673

Provider Business Practice Location Address
First Line	:	2912 SPRINGBORO W
Second Line	:	SUITE 200
City	:	MORAINE
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8999
Fax Number	:	937-298-9673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	12/15/2014

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