Provider Demographics
NPI:1275324634
Name:MANCEL, NINA MAGDALEN
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MAGDALEN
Last Name:MANCEL
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 1:382 NE 191ST ST STE 98090
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3899
Mailing Address - Country:US
Mailing Address - Phone:651-431-6628
Mailing Address - Fax:919-561-6612
Practice Address - Street 1:7901 XERXES AVE S STE 116
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1200
Practice Address - Country:US
Practice Address - Phone:651-431-6628
Practice Address - Fax:919-561-6612
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician