Provider Demographics
NPI:1659653418
Name:MANGIAGLI, TERRY P (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:P
Last Name:MANGIAGLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:16 BEARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-9320
Mailing Address - Country:US
Mailing Address - Phone:607-654-2872
Mailing Address - Fax:607-654-2878
Practice Address - Street 1:16 BEARTOWN RD
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9320
Practice Address - Country:US
Practice Address - Phone:607-654-2872
Practice Address - Fax:607-654-2878
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390962-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse