Mia Manguno, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP08405 Issued in LA

Practice address

Isu Thielen Student Health Center 2647 Union Drive
Ames, IA 50011

Phone

(515) 294-5801

NPI assigned

Nov 18, 2015

Last updated

Aug 1, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1447804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533081600000",
    "number": "1861866519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ISU THIELEN STUDENT HEALTH CENTER 2647 UNION DRIVE",
            "city": "AMES",
            "state": "IA",
            "postal_code": "500112029",
            "telephone_number": "515-294-5801",
            "fax_number": "515-294-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ISU THIELEN STUDENT HEALTH CENTER 2647 UNION DRIVE",
            "city": "AMES",
            "state": "IA",
            "postal_code": "50011",
            "telephone_number": "515-294-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUNO",
        "first_name": "MIA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-18",
        "last_updated": "2018-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP08405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2407163",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05339761",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Ames, IA
• Providers in Ames, IA by specialty
• Family Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; 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.