Provider Demographics
NPI:1629356118
Name:MANCELL, MICHELLE LEAH (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEAH
Last Name:MANCELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 N WINDING WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-4093
Mailing Address - Country:US
Mailing Address - Phone:901-355-2066
Mailing Address - Fax:
Practice Address - Street 1:7514 CORPORATE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3877
Practice Address - Country:US
Practice Address - Phone:901-755-5333
Practice Address - Fax:901-757-9233
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily