Provider Demographics
NPI:1982212163
Name:MANGEL, SARA LINDSEY (MS, RN, CPNP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LINDSEY
Last Name:MANGEL
Suffix:
Gender:F
Credentials:MS, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18370 BURBANK BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2851
Mailing Address - Country:US
Mailing Address - Phone:818-342-0793
Mailing Address - Fax:
Practice Address - Street 1:18370 BURBANK BLVD STE 204
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2851
Practice Address - Country:US
Practice Address - Phone:818-342-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95190355163W00000X
NY740019163W00000X
NYF383013363LP0200X
CA95012509363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse