Most Relevant Information
Provider Data
| NPI Number: | 1003635087 |
| Provider Name: | MARIAM MANGU NANTANG PMHNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 245103 |
Most Important Dates
| Enumeration Date: | 10/07/2024 |
| Last Updated: | 10/07/2024 |
Provider Practice Location
603 DOLLEY MADISON RD STE 100
GREENSBORO
NC
274104282
Practice Location Phone/Fax
| Phone: | 3366323505 |
| Fax: |
Provider Mailing Location
4272 JULIUS CT
GREENSBORO
NC
274068594
Provider Mailing Phone/Fax
| Phone: | 4052098497 |
| Fax: |