Individual
MS. CANDACE D MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
56 WEST MAIN STREET, NOTASULGA, AL 36866-0100
(334) 257-1081
(334) 257-1086
Mailing address
PO BOX 100, NOTASULGA, AL 36866-0100
(334) 257-1081
(334) 257-1086
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
1-090975
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051558482
PTAN
AL
01
—
1164550489
ORGANIZATIONAL NPI
—
05
—
891017112
—
AL
Enumeration date
12/01/2006
Last updated
06/08/2009
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