Healthcare Provider Details

I. General information

NPI: 1427201300
Provider Name (Legal Business Name): SEAN MATTHEW MANGAN BS, RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAKEVIEW DR
BURNSVILLE MN
55337-3824
US

IV. Provider business mailing address

1000 LAKEVIEW DR
BURNSVILLE MN
55337-3824
US

V. Phone/Fax

Practice location:
  • Phone: 952-808-8715
  • Fax:
Mailing address:
  • Phone: 952-808-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number3172
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: