Provider Demographics
NPI:1215386685
Name:MANGAN, MARGARET (RDN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:MANGAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 LAKE BOONE TRL
Mailing Address - Street 2:REX NUTRITION SERVICES WELLNESS CENTER
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6521
Mailing Address - Country:US
Mailing Address - Phone:919-784-1303
Mailing Address - Fax:919-784-1397
Practice Address - Street 1:4200 LAKE BOONE TRL
Practice Address - Street 2:REX NUTRITION SERVICES WELLNESS CENTER
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6521
Practice Address - Country:US
Practice Address - Phone:919-784-1303
Practice Address - Fax:919-784-1397
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004314133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered