Provider Demographics
NPI:1043089550
Name:MANGERY, SIIX
Entity type:Individual
Prefix:
First Name:SIIX
Middle Name:
Last Name:MANGERY
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 1:25 N THOMPSON LN STE E
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-9305
Mailing Address - Country:US
Mailing Address - Phone:724-382-4941
Mailing Address - Fax:724-590-5121
Practice Address - Street 1:25 N THOMPSON LN STE E
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-9305
Practice Address - Country:US
Practice Address - Phone:724-382-4941
Practice Address - Fax:724-590-5121
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028982363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health