Provider Demographics
NPI:1285204982
Name:MANCZ, ALLISON NICOLE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICOLE
Last Name:MANCZ
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 1:271 GLENBURN DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2116
Mailing Address - Country:US
Mailing Address - Phone:937-694-7393
Mailing Address - Fax:
Practice Address - Street 1:3700 SOUTHERN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1265
Practice Address - Country:US
Practice Address - Phone:937-281-3810
Practice Address - Fax:937-281-3812
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029115207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine