Individual
NICOLE MANGUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-2250
(859) 572-2326
Mailing address
PO BOX 18667, ERLANGER, KY 41018-0667
(859) 572-3617
(859) 572-2326
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3014214
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0387021
—
OH
05
—
7100648190
—
KY
Enumeration date
01/16/2020
Last updated
07/22/2021
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