Individual provider · Type 1 NPI

Ethan Rafael Mangum

Student in an Organized Health Care Education/Training Program · Layton, UT

NPI number 1134979495 Active

Practice location

1172 W Seraphim Ct
Layton, UT 84041-2213

Call (385) 439-3790 Map

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1134979495

Ethan Rafael Mangum's National Provider Identifier is 1134979495, issued on Mar 26, 2024. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Layton, UT. The record was last updated on Mar 26, 2024.