Julia Mangan, FNP, Family Practice Clinic P.C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

NP334A Issued in ID

Legal business name

JULIA MANGAN, FNP, FAMILY PRACTICE CLINIC P.C

Practice address

1112 W Ironwood Dr
Coeur D Alene, ID 83814-2474

Phone

(208) 664-8818

Fax

(208) 664-4427

NPI assigned

Aug 13, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Julia B Mangan, FNP

Title

Owner

Phone

(208) 664-8818

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369699200000",
    "number": "1699787168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 W IRONWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142474",
            "telephone_number": "208-664-8818",
            "fax_number": "208-664-4427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 W IRONWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142474",
            "telephone_number": "208-664-8818",
            "fax_number": "208-664-4427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JULIA MANGAN, FNP, FAMILY PRACTICE CLINIC P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2013-05-28",
        "status": "A",
        "authorized_official_last_name": "MANGAN",
        "authorized_official_first_name": "JULIA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-664-8818",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "NP334A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805117600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; 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.