Provider Demographics
NPI:1538791439
Name:MANGUM, RUTH ERNITA
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ERNITA
Last Name:MANGUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6390 GREENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-8408
Mailing Address - Country:US
Mailing Address - Phone:202-341-9958
Mailing Address - Fax:
Practice Address - Street 1:2234 12TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4404
Practice Address - Country:US
Practice Address - Phone:202-341-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion