Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 300159 | NC |
NPI | 1114265824 |
---|---|
Provider Name | Amy Yancy Mangum |
First Address | Durham, NC 27705-3824 |
Second Address | Durham, NC 27710-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2013 |
Last Update Date | 30/01/2013 |