| Doctor Name: | MARIE WHITMAN MANGINO |
| NPI Number: | 1053517250 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | C.R.N.P. |
| License Number: | SP001552H |
| Business Practice Address: | 851 Skyline Dr Erdenheim, PA - 190381846 |
| Business Phone Number: | 2152335058 |
| Business Fax Number: | 2152331282 |
| Mailing Address: | 851 Skyline Dr, ERDENHEIM |
| State: | PA |
| Postal Code: | 190381846 |
| Phone Number: | 2152335058 |
| Fax Number: | 2152331282 |
| NPI Enumeration Date: | 06/25/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | SP001552H |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |