Provider Demographics
NPI:1053861146
Name:MANGAN-DANCKWART, DEBORAH (DNP, RN, APRN, CNS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:MANGAN-DANCKWART
Suffix:
Gender:F
Credentials:DNP, RN, APRN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67726 207TH AVE
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-2196
Mailing Address - Country:US
Mailing Address - Phone:507-261-7108
Mailing Address - Fax:
Practice Address - Street 1:67726 207TH AVE
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-2196
Practice Address - Country:US
Practice Address - Phone:507-261-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 86423-3364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health