Provider Demographics
NPI:1578221859
Name:MANUEL, ANGELITA (DNP)
Entity Type:Individual
Prefix:
First Name:ANGELITA
Middle Name:
Last Name:MANUEL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:MANUEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP
Mailing Address - Street 1:5444 BARABOO CT
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-4873
Mailing Address - Country:US
Mailing Address - Phone:309-883-1373
Mailing Address - Fax:
Practice Address - Street 1:5444 BARABOO CT
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-4873
Practice Address - Country:US
Practice Address - Phone:309-883-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA157318363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care