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General NPI Number Information
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NPI Number | 1043883929
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Entity Type | Individual
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Provider Name | REBECCA A MANGOL RN
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Gender | Female
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 2115 W PARK DR
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City | LORAIN
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State | OH
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Zip | 44053-1138
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Country | US
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Telephone | 440-989-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 7573 AKINS RD
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City | NORTH ROYALTON
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State | OH
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Zip | 44133-4809
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Country | US
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Telephone | 330-523-6231
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN430791
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | RN430791
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License Number State | OH
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