Healthcare Provider Details

I. General information

NPI: 1417848979
Provider Name (Legal Business Name): BRIANA MANGAN APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N RIDGE RD
ELYRIA OH
44035-1241
US

IV. Provider business mailing address

2100 N RIDGE RD
ELYRIA OH
44035-1241
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-1300
  • Fax: 440-277-0409
Mailing address:
  • Phone: 440-324-1300
  • Fax: 440-277-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0039659
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: