Provider Demographics
NPI:1255045951
Name:MANCUSO, KIM MICHELLE (CD(DONA))
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:MICHELLE
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1722
Mailing Address - Country:US
Mailing Address - Phone:609-651-5859
Mailing Address - Fax:
Practice Address - Street 1:141 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1722
Practice Address - Country:US
Practice Address - Phone:609-651-5859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula