Individual
JUSTINE MARIE MANGLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5301 MCAULEY DR, YPSILANTI, MI 48197-1051
(734) 712-3456
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-8700
(414) 259-1522
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4495
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285129213
—
WI
Enumeration date
06/22/2018
Last updated
06/07/2023
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