Provider Demographics
NPI:1386807154
Name:MANGIERI, HEATHER RAE (MS, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RAE
Last Name:MANGIERI
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:PA
Mailing Address - Zip Code:15126-1170
Mailing Address - Country:US
Mailing Address - Phone:412-445-1889
Mailing Address - Fax:
Practice Address - Street 1:815 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:PA
Practice Address - Zip Code:15126-1170
Practice Address - Country:US
Practice Address - Phone:412-445-1889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000933133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered