Provider Demographics
NPI:1568033660
Name:MANCZKO, SARAH FRANCES (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:FRANCES
Last Name:MANCZKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 14-044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-908-8163
Mailing Address - Fax:312-695-1394
Practice Address - Street 1:676 N SAINT CLAIR ST STE 14-044
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-908-8163
Practice Address - Fax:312-695-1394
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC0010-11342363A00000X
IL085009262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant