Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F401339 | NY |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R226503 | MD |
NPI | 1013206655 |
---|---|
Provider Name | Ms. Grace Manglet |
First Address | Rockville, MD 20850-8724 |
Second Address | Rockville, MD 20850-8724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2011 |
Last Update Date | 20/04/2017 |