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General NPI Number Information
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NPI Number | 1316175474
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Entity Type | Individual
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Provider Name | SHAWN M MANGAN CRNP
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Gender | Female
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 111 S 11TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4824
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Country | US
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Telephone | 215-355-8304
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Fax | 215-923-0835
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Provider Business Mailing Address
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Address Line | 4300 BOONE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19128-4901
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Country | US
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Telephone | 856-296-6552
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | SP010334
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License Number State | PA
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