Provider Demographics
NPI:1316766546
Name:MANGOLD, JENNIFER MICHELLE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:MANGOLD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BARBARA LN
Mailing Address - Street 2:
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-6327
Mailing Address - Country:US
Mailing Address - Phone:206-734-9879
Mailing Address - Fax:
Practice Address - Street 1:11410 NE 122ND WAY
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6945
Practice Address - Country:US
Practice Address - Phone:425-650-4005
Practice Address - Fax:425-215-4846
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00141090163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse