Individual
MS. KELLY RENEE MANGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3 SCARLET OAK CT, LAKE ST LOUIS, MO 63367-2130
(312) 919-6286
Mailing address
3 SCARLET OAK CT, LAKE ST LOUIS, MO 63367-2130
(312) 919-6286
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
2010005602
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
6708
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600420070
—
MO
Enumeration date
03/12/2010
Last updated
06/28/2023
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