Individual
FORTUNATE MANGWENDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2990
Mailing address
1521 WRIGHT ST, AUBREY, TX 76227-1593
(402) 319-3406
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95305947
CA
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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