Provider Demographics
NPI:1609556992
Name:MANYAME, NYASHA
Entity Type:Individual
Prefix:
First Name:NYASHA
Middle Name:
Last Name:MANYAME
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 1:6010 MILLS CIVIC PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8375
Mailing Address - Country:US
Mailing Address - Phone:515-221-7800
Mailing Address - Fax:
Practice Address - Street 1:6010 MILLS CIVIC PKWY
Practice Address - Street 2:STE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8375
Practice Address - Country:US
Practice Address - Phone:515-471-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA174066363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care