Provider Demographics
NPI:1356824072
Name:MANTERNACH, MICHELLE MARGARET (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARGARET
Last Name:MANTERNACH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARGARET
Other - Last Name:HEINZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-8822
Mailing Address - Fax:319-467-1002
Practice Address - Street 1:1632 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240
Practice Address - Country:US
Practice Address - Phone:319-384-8822
Practice Address - Fax:319-467-1002
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA132237363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner