Provider Demographics
NPI:1780035493
Name:VEGA, MANDIE DENISE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MANDIE
Middle Name:DENISE
Last Name:VEGA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:MANDIE
Other - Middle Name:DENISE
Other - Last Name:SLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:705 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARMAN
Mailing Address - State:TX
Mailing Address - Zip Code:79081-3407
Mailing Address - Country:US
Mailing Address - Phone:806-659-2846
Mailing Address - Fax:
Practice Address - Street 1:705 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:SPEARMAN
Practice Address - State:TX
Practice Address - Zip Code:79081-3407
Practice Address - Country:US
Practice Address - Phone:806-659-2846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily