MEDICARE: ELIZABETH MANGIERI-OMPS 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	363LF0000X	Family Nurse Practitioner	0024164587	VA

General Provider Information

NPI Number	:	1639157969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MANGIERI-OMPS NP

Provider Business Mailing Address
First Line	:	9434 HOSPITAL AVENUE
Second Line	:
City	:	NASSAWADOX
State	:	VA
Zip	:	23413
Country	:	US
Telephone Number	:	757-414-0400
Fax Number	:	757-414-0569

Provider Business Practice Location Address
First Line	:	20280 MARKET ST
Second Line	:
City	:	ONANCOCK
State	:	VA
Zip	:	23417-1331
Country	:	US
Telephone Number	:	757-787-7374
Fax Number	:	757-787-4513

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/08/2007

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