Sandra Kay Mangan, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704160601 Issued in MI

Practice address

3415 28TH St
Port Huron, MI 48060-6931

Phone

(810) 987-5300

NPI assigned

Apr 1, 2009

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• County of St Clair

  • Public Health or Welfare Agency
  • Port Huron, MI
  • NPI 1053408948
  NPD (past)
• Downriver Community Services Inc.

  • Federally Qualified Health Center (FQHC)
  • Port Huron, MI
  • NPI 1508703570
  NPD (past)
• St Clair County Health Department

  • Public Health or Welfare Agency
  • Port Huron, MI
  • NPI 1245561620
  NPD (past)

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

{
    "created_epoch": "1238544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312761600000",
    "number": "1326280587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21089 SOUTHWAY DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480442242",
            "telephone_number": "586-598-6947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 28TH ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606931",
            "telephone_number": "810-987-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGAN",
        "first_name": "SANDRA",
        "middle_name": "KAY",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-01",
        "last_updated": "2011-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704160601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tairan Dale Malachi- Cooney
• Jennifer J Maladecki, LLMSW
• Jessica Malburg
• Heather Lyn Malinski, LLMSW
• Linda J Mang, LPC
• Stephanie Maniaci, FNP
• Carol Ann Mann, LBSW QMRP
• George Michael Mantas, L.L.P.
• Daniel James Marcath, FNP
• Grace Markey, MD

• Family Nurse Practitioner in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2011; 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.