Provider Demographics
NPI:1760838684
Name:MANCHA, ELISABETH (NP)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:MANCHA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N 7TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2754
Mailing Address - Country:US
Mailing Address - Phone:602-277-6181
Mailing Address - Fax:
Practice Address - Street 1:1331 N 7TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2754
Practice Address - Country:US
Practice Address - Phone:602-277-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8660363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care