Provider Demographics
NPI:1689110736
Name:MANGOLD, EMMA CAROLINE (CRNA DNP-A)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:CAROLINE
Last Name:MANGOLD
Suffix:
Gender:F
Credentials:CRNA DNP-A
Other - Prefix:DR
Other - First Name:EMMA
Other - Middle Name:CAROLINE
Other - Last Name:WEATHERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1776
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-1776
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5926
Practice Address - Country:US
Practice Address - Phone:907-729-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK118586367500000X
FLAPRN11021077367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered