| NPI | 1255978631 |
|---|---|
| Former Name | CRYSTAL MANGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OK M0137463) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 79127) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 137463) | |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2024-07-15 |