Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 572721 | TX |
NPI | 1174541452 |
---|---|
Provider Name | Anna Mangiafico |
First Address | San Antonio, TX 78229-3641 |
Second Address | San Antonio, TX 78229-3641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |