Provider Demographics
NPI:1013206655
Name:MANGLET, GRACE (DNP ( PMH-NP-BC))
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:MANGLET
Suffix:
Gender:F
Credentials:DNP ( PMH-NP-BC)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17805 TERI DR
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1344
Mailing Address - Country:US
Mailing Address - Phone:301-250-5830
Mailing Address - Fax:301-637-7970
Practice Address - Street 1:18403 WOODFIELD RD STE D
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-4794
Practice Address - Country:US
Practice Address - Phone:301-250-0404
Practice Address - Fax:301-637-7970
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401339363LP0808X
MDR226503363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health