Provider Demographics
NPI:1396409983
Name:MANGI, JAYNE MARIE (WHNP)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:MARIE
Last Name:MANGI
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-7882
Mailing Address - Fax:314-454-5167
Practice Address - Street 1:4901 FOREST PARK AVE
Practice Address - Street 2:DEPT OBGYN, STE 341
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1495
Practice Address - Country:US
Practice Address - Phone:314-454-7882
Practice Address - Fax:314-454-5167
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021040984363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420106501Medicaid