Individual
MRS. SANDRA KAY MANGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3415 28TH ST, PORT HURON, MI 48060-6931
(810) 987-5300
Mailing address
21089 SOUTHWAY DR, MACOMB, MI 48044-2242
(586) 598-6947
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704160601
MI
Other
Enumeration date
04/01/2009
Last updated
08/08/2011
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