Provider Demographics
NPI:1114265824
Name:MANGUM, AMY YANCY (MSN, NNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:YANCY
Last Name:MANGUM
Suffix:
Gender:F
Credentials:MSN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 ERWIN RD
Mailing Address - Street 2:SUITE 504, NEONATOLOGY
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3824
Mailing Address - Country:US
Mailing Address - Phone:919-970-8255
Mailing Address - Fax:919-681-6065
Practice Address - Street 1:5524 HOSPITAL N
Practice Address - Street 2:BOX 100500 MEDICAL CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-970-8255
Practice Address - Fax:919-681-6065
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300159363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care