Individual
MR. JUSTIN MANGANARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PNP
Contact information
Practice address
789 CENTRAL AVE, DOVER, NH 03820-2526
(603) 740-2263
(603) 740-2402
Mailing address
PO BOX 412503, BOSTON, MA 02241-2503
(037) 402-4136
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
083906-23
NH
363LP0200X
Pediatric Nurse Practitioner
APRN00140
RI
363LP0200X
Pediatric Nurse Practitioner
RN266873
MA
Other
Enumeration date
12/15/2010
Last updated
02/03/2021
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