Individual
STEPHANIE C MANGUAL LEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
255 LANCASTER DR NE, SALEM, OR 97301-5155
(787) 298-7480
(503) 364-0775
Mailing address
255 LANCASTER DR NE, SALEM, OR 97301-5155
(503) 576-8400
(503) 364-0775
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
231604
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
10014644
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F406522
NY
Other
Enumeration date
05/02/2023
Last updated
07/16/2025
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