Provider Demographics
NPI:1043202864
Name:MANCHESTER, MARGARET KIMMAN (MS, FNP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:KIMMAN
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:MS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5461 E ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1415
Mailing Address - Country:US
Mailing Address - Phone:480-941-9283
Mailing Address - Fax:480-941-9286
Practice Address - Street 1:8117 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3818
Practice Address - Country:US
Practice Address - Phone:480-941-9283
Practice Address - Fax:480-941-9286
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN055467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS47540Medicare UPIN
AZ21384Medicare ID - Type Unspecified