Provider Demographics
NPI:1073979084
Name:MANGIAMELE, CONSTANCE J (APRN)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:J
Last Name:MANGIAMELE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CONSTANCE
Other - Middle Name:J
Other - Last Name:MANGIAMELE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN FNP
Mailing Address - Street 1:1012 MAPLE RIDGE CT NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-8020
Mailing Address - Country:US
Mailing Address - Phone:218-766-5247
Mailing Address - Fax:
Practice Address - Street 1:190 SAILSTAR DR. NW
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633
Practice Address - Country:US
Practice Address - Phone:218-335-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR149441-1163W00000X
MNR1494411363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner