Provider Demographics
NPI:1790566750
Name:MANGELSDORF, AUSTIN GERARD (RN)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:GERARD
Last Name:MANGELSDORF
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 PERIMETER LOOP APT 204
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8332
Mailing Address - Country:US
Mailing Address - Phone:404-312-1721
Mailing Address - Fax:
Practice Address - Street 1:283 PERIMETER LOOP APT 204
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8332
Practice Address - Country:US
Practice Address - Phone:404-312-1721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program