Provider Demographics
NPI:1720095474
Name:MANGELSEN, JAN C (CNM)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:C
Last Name:MANGELSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 FLORMANN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-342-7400
Mailing Address - Fax:605-342-8239
Practice Address - Street 1:640 FLORMANN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-342-7400
Practice Address - Fax:605-342-8239
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCM000017176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife