Provider Demographics
NPI:1982887097
Name:MANGENEY, BRIANNE JOAN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:JOAN
Last Name:MANGENEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 LAWN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1551
Mailing Address - Country:US
Mailing Address - Phone:215-453-3300
Mailing Address - Fax:215-453-3306
Practice Address - Street 1:915 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960
Practice Address - Country:US
Practice Address - Phone:215-453-3300
Practice Address - Fax:215-453-3306
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009647363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023375640001Medicaid
PA123842Medicare PIN