Individual provider · Type 1 NPI

Vadewattie Mangru, NP

Primary Care Nurse Practitioner · Jamaica, NY

NPI number 1467546317 Active

Practice location

82-68 164th St
Jamaica, NY 11432-1121

Call (718) 883-3225 Map

Fax (718) 883-6193

Mailing address

79-01 Broadway, D1-01
Elmhurst, NY 11373-1329

Specialties and licenses

Taxonomy	Code	License
Primary Care Nurse Practitioner Primary	363LP2300X	F331468 (NY)

Primary Care Nurse Practitioner: Definition to come...

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About NPI 1467546317

Vadewattie Mangru, NP's National Provider Identifier is 1467546317, issued on Oct 3, 2006. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Jamaica, NY. The record was last updated on Jul 8, 2007.