Provider Demographics
NPI:1952920829
Name:MANGA, ALBERTA (RN)
Entity Type:Individual
Prefix:
First Name:ALBERTA
Middle Name:
Last Name:MANGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7671 GRANBY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2365
Mailing Address - Country:US
Mailing Address - Phone:513-295-4372
Mailing Address - Fax:
Practice Address - Street 1:7671 GRANBY WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2365
Practice Address - Country:US
Practice Address - Phone:513-295-4372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN264589163WH0200X, 163WR0400X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation