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1639787633 NPI number — ALICIA MCKENZIE MANGIN MPH, PA-C

NPI Number: 1639787633
Health Care Provider/Practitioner: ALICIA MCKENZIE MANGIN MPH, PA-C

Information about “1639787633” NPI (ALICIA MCKENZIE MANGIN MPH, PA-C) exists in 1639787633 in HTML format HTML  |  1639787633 in plain Text format TXT  |  1639787633 in PDF (Portable Document Format) PDF  |  1639787633 in an XML format XML  formats.

NPI Number : 1639787633 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639787633",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MANGIN",
    "FirstName": "ALICIA",
    "MiddleName": "MCKENZIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MPH, PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2082 KATYDID CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WARRINGTON",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "18976-1323",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "215-589-5012",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1 CAPITAL WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PENNINGTON",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08534-2520",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "800-637-2374",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/16/2020",
    "LastUpdateDate": "05/21/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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