Provider Demographics
NPI:1427201300
Name:MANGAN, SEAN MATTHEW (BS, RRT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:MATTHEW
Last Name:MANGAN
Suffix:
Gender:M
Credentials:BS, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3824
Mailing Address - Country:US
Mailing Address - Phone:952-808-8715
Mailing Address - Fax:
Practice Address - Street 1:1000 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3824
Practice Address - Country:US
Practice Address - Phone:952-808-8715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3172227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered