Individual
LYDIA ROSE MANGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8402 HARCOURT RD STE 100, INDIANAPOLIS, IN 46260
(317) 338-7674
Mailing address
8402 HARCOURT RD STE 100, INDIANAPOLIS, IN 46260-2006
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10002502A
IN
Other
Enumeration date
07/26/2018
Last updated
07/20/2022
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