Provider Demographics
NPI:1922329416
Name:MANCARI, ROANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ROANNE
Middle Name:
Last Name:MANCARI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 CHENEY DR W # 160
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3741
Mailing Address - Country:US
Mailing Address - Phone:208-944-0497
Mailing Address - Fax:208-944-0506
Practice Address - Street 1:476 CHENEY DR W # 160
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3741
Practice Address - Country:US
Practice Address - Phone:208-944-0497
Practice Address - Fax:208-944-0506
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP986A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily