Individual
MEEGAN MARIE MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9427 SW BARNES RD, SUITE 498, PORTLAND, OR 97225-6652
(503) 216-0900
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA165383
OR
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500664531
—
OR
01
—
P01494183
RR MEDICARE - PH&S
OR
Enumeration date
09/25/2013
Last updated
06/18/2021
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