Mariam Mangu Nantang, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

245103 Issued in NC

Practice address

717 Green Valley Rd Ste 200
Greensboro, NC 27408-2156

Phone

(743) 222-9755

NPI assigned

Oct 7, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Evergreen Psychiatry Group PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Greensboro, NC
  • NPI 1700698164

  Psychiatric/Mental Health

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1003635087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 GREEN VALLEY RD STE 200",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274082156",
            "telephone_number": "743-222-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 GREEN VALLEY RD STE 200",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274082156",
            "telephone_number": "743-222-9755"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1140 Kildaire Farm Rd Rm 12",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "NC",
            "postal_code": "275114562",
            "country_code": "US",
            "telephone_number": "743-222-9755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NANTANG",
        "first_name": "MARIAM",
        "middle_name": "MANGU",
        "name_prefix": "Mrs.",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-07",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "245103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Garrett Nance, AU.D., CCC-A
• Nancys Family Home Care Agency LLC
• April H Nandigam, NP
• Kavitha Veena Nandigam, MD
• Giuliana Nanetti
• Naomi Lane, D.D.S., P.a. (Piedmont Pediatric Dentistry)
• Jennifer Michelle Nappi, CPP
• Alexa Nardone, PHARMD
• Nischal Narendra, M.B.B.S
• Narrow Road Physical Therapy, LLC

• Psychiatric/Mental Health Nurse Practitioner in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.