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General NPI Number Information
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NPI Number | 1912718065
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Entity Type | Individual
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Provider Name | MIKHAYLA BROOKE MANGANELLO
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Gender | Female
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 5508 OLD HICKORY BLVD STE B
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City | HERMITAGE
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State | TN
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Zip | 37076-2588
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Country | US
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Telephone | 615-391-9006
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 BELVIDERE DR
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City | NASHVILLE
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State | TN
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Zip | 37204-3916
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Country | US
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Telephone |
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 1067
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License Number State | TN
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