Provider Demographics
NPI:1962988873
Name:MANGER, ROXANA KOREN (CPNP-AC)
Entity type:Individual
Prefix:MRS
First Name:ROXANA
Middle Name:KOREN
Last Name:MANGER
Suffix:
Gender:
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53536-2203
Mailing Address - Country:US
Mailing Address - Phone:608-843-0769
Mailing Address - Fax:
Practice Address - Street 1:682 PORTER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53536-2203
Practice Address - Country:US
Practice Address - Phone:608-843-0769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16545-33363LP0200X
WI168550163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse