Provider Demographics
NPI:1326515503
Name:MANGIDOYOS, WILMA DAR (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:DAR
Last Name:MANGIDOYOS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11412 SE 193RD TER
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-0038
Mailing Address - Country:US
Mailing Address - Phone:206-209-6313
Mailing Address - Fax:
Practice Address - Street 1:10344 14TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-1689
Practice Address - Country:US
Practice Address - Phone:206-245-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00163599163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse