Individual
MRS. ALICIA MIREYA MANGANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2222 W DIVISION ST, CHICAGO, IL 60622-2717
(773) 541-8100
Mailing address
2222 W DIVISION ST STE 340, CHICAGO, IL 60622-2995
(773) 541-8100
(773) 541-8109
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
209.016499
IL
363LF0000X
Family Nurse Practitioner
Primary
209.016499
IL
Other
Enumeration date
09/13/2017
Last updated
04/08/2020
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