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General NPI Number Information
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NPI Number | 1326280587
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Entity Type | Individual
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Provider Name | SANDRA KAY MANGAN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 08/08/2011
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Provider Practice Location Address
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Address Line | 3415 28TH ST
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City | PORT HURON
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State | MI
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Zip | 48060-6931
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Country | US
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Telephone | 810-987-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 21089 SOUTHWAY DR
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City | MACOMB
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State | MI
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Zip | 48044-2242
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Country | US
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Telephone | 586-598-6947
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704160601
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License Number State | MI
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