Provider Demographics
NPI:1700112018
Name:MANGOLD, LAUREN ASHLEY (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ASHLEY
Last Name:MANGOLD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ASHLEY
Other - Last Name:WEISSBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7050 N RECREATION AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8001
Mailing Address - Country:US
Mailing Address - Phone:559-325-3515
Mailing Address - Fax:
Practice Address - Street 1:7050 N RECREATION AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8001
Practice Address - Country:US
Practice Address - Phone:559-325-3515
Practice Address - Fax:559-325-3526
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X, 374J00000X
CA236103367A00000X
MN0280367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No374J00000XNursing Service Related ProvidersDoula