Healthcare Provider Details

I. General information

NPI: 1639157969
Provider Name (Legal Business Name): ELIZABETH MANGIERI-OMPS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20280 MARKET ST
ONANCOCK VA
23417-1331
US

IV. Provider business mailing address

9434 HOSPITAL AVENUE
NASSAWADOX VA
23413
US

V. Phone/Fax

Practice location:
  • Phone: 757-787-7374
  • Fax: 757-787-4513
Mailing address:
  • Phone: 757-414-0400
  • Fax: 757-414-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164587
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: