Individual
MIA MANGUNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
ISU THIELEN STUDENT HEALTH CENTER 2647 UNION DRIVE, AMES, IA 50011
(515) 294-5801
Mailing address
ISU THIELEN STUDENT HEALTH CENTER 2647 UNION DRIVE, AMES, IA 50011-2029
(515) 294-5801
(515) 294-1190
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP08405
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05339761
—
MS
05
—
2407163
—
LA
Enumeration date
11/18/2015
Last updated
08/01/2018
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