Provider Demographics
NPI:1861857039
Name:MANZELLA, JOAN MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:MANZELLA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-684-3701
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:143 GARDEN HOMES DR
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114
Practice Address - Country:US
Practice Address - Phone:509-684-3701
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-51475163W00000X
IDNP-1679A363LF0000X
ARA005021363LF0000X
WAAP60892172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily