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MS. CANDACE D MANGUM CRNP

Primary Care >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1407924384

Individual Registrant:
MS. CANDACE D MANGUM CRNP
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

Contact information for business:
PO BOX 100  NOTASULGA, AL 36866-0100 US
Tel: 334-257-1081  Fax: 334-257-1086

Registration Information:
NPI: 1407924384
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LP2300XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Primary Care
AL1-090975

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
PTAN051558482AL01
ORGANIZATIONAL NPI116455048901
891017112AL05




HEALTH CARE JOBS AL - Page 1



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