Provider Demographics
NPI:1255484143
Name:MANGRUM, BARBARA JANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JANE
Last Name:MANGRUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6052
Mailing Address - Country:US
Mailing Address - Phone:318-357-3122
Mailing Address - Fax:318-357-3240
Practice Address - Street 1:210 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6052
Practice Address - Country:US
Practice Address - Phone:318-357-3122
Practice Address - Fax:318-357-3240
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN036601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse