Individual
MRS. DEBRA D MANGRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3800 W 203RD ST STE 204, OLYMPIA FIELDS, IL 60461-1185
(708) 852-2641
(708) 503-3260
Mailing address
35318 EAGLE WAY, CHICAGO, IL 60678-1353
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209015375
IL
363LA2200X
Adult Health Nurse Practitioner
71007051A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300024535
—
IN
Enumeration date
12/29/2016
Last updated
12/15/2021
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