Healthcare Provider Details

I. General information

NPI: 1649216615
Provider Name (Legal Business Name): ELSIE MANGANO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OLD DENBIGH BLVD SUITE 1020A
NEWPORT NEWS VA
23602-2017
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD SUITE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-875-2050
  • Fax: 757-875-2070
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024165754
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: