Healthcare Provider Details

I. General information

NPI: 1780595892
Provider Name (Legal Business Name): ANNETTE LYNN MANGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 DAVIS RD
MANSFIELD OH
44907-1122
US

IV. Provider business mailing address

460 DAVIS RD
MANSFIELD OH
44907-1122
US

V. Phone/Fax

Practice location:
  • Phone: 419-525-6321
  • Fax: 419-525-6386
Mailing address:
  • Phone: 419-525-6321
  • Fax: 419-525-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN279568
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: