Provider Demographics
NPI:1710357900
Name:MANGIN, ERIKA SUSANNE (RN, APN, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:SUSANNE
Last Name:MANGIN
Suffix:
Gender:F
Credentials:RN, APN, PMHNP-BC
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:S
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 22040
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2040
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:301 E SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-619-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI223907163W00000X
MA2303712163W00000X
IL041.451974163W00000X
WI8506-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
2017009243OtherAMERICAN NURSES CREDENTIALING CENTER