Provider Demographics
NPI:1427478007
Name:MANG, JANE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 UINTA WAY STE 140
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7198
Mailing Address - Country:US
Mailing Address - Phone:303-432-8487
Mailing Address - Fax:866-716-7233
Practice Address - Street 1:495 UINTA WAY STE 140
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7198
Practice Address - Country:US
Practice Address - Phone:303-432-8487
Practice Address - Fax:866-716-7233
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E0000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health