MEREDITH MANGUM FNP-C NPI 1740663657

NPI Information

NPI: 1740663657
Provider Name: MEREDITH MANGUM, FNP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: DAVID J BUTUK MD PA

PECOS Registration: Yes

Address:
608 S PHILLIPPI ST
BOISE, ID
ZIP 83705
Phone: (208) 580-8888
Get Directions

Meredith Mangum, FNP-C is a family nurse practitioner in Boise, ID with 9 years of experience. Meredith Mangum, FNP-C NPI is 1740663657. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

608 S PHILLIPPI ST
BOISE, ID
ZIP 83705-160
Phone: (208) 580-8888

The NPI 1740663657 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/9/2015 and was last updated on 9/30/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	NP-1579A	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	NP-1579A	OTHER	IDAHO	LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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