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MS. CANDACE D MANGUM CRNP
Primary Care >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1407924384
Individual Registrant:MS. CANDACE D MANGUM CRNP
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
56 WEST MAIN STREET NOTASULGA, AL 36866-0100 US
Tel: 334-257-1081 Fax: 334-257-1086
Tel: 334-257-1081 Fax: 334-257-1086
Contact information for business:
PO BOX 100 NOTASULGA, AL 36866-0100 US
Tel: 334-257-1081 Fax: 334-257-1086
Tel: 334-257-1081 Fax: 334-257-1086
Registration Information:
NPI: 1407924384
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Primary Care | AL | 1-090975 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| PTAN | 051558482 | AL | 01 |
| ORGANIZATIONAL NPI | 1164550489 | 01 | |
| 891017112 | AL | 05 |
