| NPI | 1386303329 |
|---|---|
| Former Name | ABIGAIL DIANE MANGOLD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209024540) |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2021-12-16 |