Individual
ANNALEE MANGUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
257 ELAINE LN, DONNELLY, ID 83615-5079
(208) 484-4565
Mailing address
257 ELAINE LN, DONNELLY, ID 83615-5079
(208) 484-4565
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
35135
ID
Other
Enumeration date
01/13/2025
Last updated
01/13/2025
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