Individual
DR. AUDREY N MANGWIRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
700 E MARSHALL AVE, LONGVIEW, TX 75601-5580
(903) 315-1488
(903) 315-1656
Mailing address
PO BOX 2701, LONGVIEW, TX 75606-2701
(903) 315-1488
(903) 315-1656
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
M4318
TX
207R00000X
Internal Medicine Physician
15590R
LA
207R00000X
Internal Medicine Physician
Primary
M4318
TX
208M00000X
Hospitalist Physician
74111
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1476510
—
LA
Enumeration date
07/13/2006
Last updated
05/16/2023
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