MEDICARE: KATHRYN A MANGION NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	LB-0000286	DE
2	363LW0102X	Women's Health Nurse Practitioner	LH-0000208	DE

General Provider Information

NPI Number	:	1164405163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN A MANGION NP

Provider Business Mailing Address
First Line	:	18947 JOHN J WILLIAMS HWY
Second Line	:
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-4474
Country	:	US
Telephone Number	:	302-645-3121
Fax Number	:

Provider Business Practice Location Address
First Line	:	18947 JOHN J WILLIAMS HWY
Second Line	:	SUITE 210
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-4474
Country	:	US
Telephone Number	:	302-645-3121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	12/26/2016

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