Individual provider Active NPI

Jennifer Michelle Mangold, REGISTERED NURSE

  • Registered Nurse
  • Kirkland, WA
National Provider Identifier
1316766546
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN00141090 Issued in WA
Practice address
11410 NE 122ND Way
Kirkland, WA 98034-6945
Phone
(425) 650-4005
Fax
(425) 215-4846
NPI assigned
Oct 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN00141090 WA Primary

Addresses

Primary practice location

11410 NE 122ND Way
Kirkland, WA 98034-6945

Mailing address

26 Barbara LN
Camano Island, WA 98282-6327
Phone (206) 734-9879

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RN00141090WAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Connectionswa, LLC PastSince Oct 6, 2024 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1728000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1316766546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 BARBARA LN",
            "city": "CAMANO ISLAND",
            "state": "WA",
            "postal_code": "982826327",
            "telephone_number": "206-734-9879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11410 NE 122ND WAY",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980346945",
            "telephone_number": "425-650-4005",
            "fax_number": "425-215-4846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGOLD",
        "first_name": "JENNIFER",
        "middle_name": "MICHELLE",
        "name_prefix": "Ms.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-04",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00141090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.