Provider Demographics
NPI:1760988992
Name:MANTY, JOANN L (RN)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:L
Last Name:MANTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:L
Other - Last Name:JUNTILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7255 COUNTY ROAD PI
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-8841
Mailing Address - Country:US
Mailing Address - Phone:906-486-6216
Mailing Address - Fax:
Practice Address - Street 1:901 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-1367
Practice Address - Country:US
Practice Address - Phone:906-485-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704117730163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator