Provider Demographics
NPI:1417215278
Name:MANGES, LUCINDA GRACE (CNM)
Entity Type:Individual
Prefix:MS
First Name:LUCINDA
Middle Name:GRACE
Last Name:MANGES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MARTIN AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1761
Mailing Address - Country:US
Mailing Address - Phone:717-721-5700
Mailing Address - Fax:717-721-5712
Practice Address - Street 1:175 MARTIN AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1761
Practice Address - Country:US
Practice Address - Phone:717-721-5700
Practice Address - Fax:717-721-5712
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010274367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA240573UFWOtherMEDICARE PTAN