Provider Demographics
NPI:1326373952
Name:MANHART, ANDREA NICOLETTE (D O,)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:NICOLETTE
Last Name:MANHART
Suffix:
Gender:F
Credentials:D O,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4034
Mailing Address - Fax:970-490-4347
Practice Address - Street 1:4110 BRIARGATE PKWY STE 405
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7838
Practice Address - Country:US
Practice Address - Phone:719-365-7300
Practice Address - Fax:719-365-7301
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00616272084N0400X
OH58.0031932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH89318Medicaid
OH34.010718OtherMEDICAL LICENSE