Healthcare Provider Details

I. General information

NPI: 1699494153
Provider Name (Legal Business Name): AARON MANGIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 OPUS PL STE 110
DOWNERS GROVE IL
60515-1164
US

IV. Provider business mailing address

1431 OPUS PL STE 110
DOWNERS GROVE IL
60515-1164
US

V. Phone/Fax

Practice location:
  • Phone: 888-279-0002
  • Fax:
Mailing address:
  • Phone: 888-279-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1125707
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number061073482
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.026233
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28243197A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71013243A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: