Provider Demographics
NPI:1700218005
Name:MANGIARACINA, KORIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:KORIE
Middle Name:
Last Name:MANGIARACINA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 JACKSONVILLE RD APT 146F
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2639
Mailing Address - Country:US
Mailing Address - Phone:319-430-8166
Mailing Address - Fax:
Practice Address - Street 1:650 DURHAM RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-9618
Practice Address - Country:US
Practice Address - Phone:267-217-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002064133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered