Individual
COURTNEY MANGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28160425A
IN
Other
Enumeration date
05/24/2019
Last updated
05/24/2019
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