Individual
JADEKA MOTLEY MANGRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
700 WALTER REED DR, GREENSBORO, NC 27403-1128
(336) 210-5641
Mailing address
700 GLENDALE DR APT H, GREENSBORO, NC 27406-6469
(362) 105-6413
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5018483
NC
Other
Enumeration date
07/19/2023
Last updated
07/20/2023
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