Provider Demographics
NPI:1205593514
Name:MANGENA, NOMUHLE
Entity type:Individual
Prefix:
First Name:NOMUHLE
Middle Name:
Last Name:MANGENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23850 W COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-8270
Mailing Address - Country:US
Mailing Address - Phone:269-290-3225
Mailing Address - Fax:
Practice Address - Street 1:23850 W COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-8270
Practice Address - Country:US
Practice Address - Phone:269-290-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704245956363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care