Provider Demographics
NPI:1376388629
Name:MANAYE, MINTWAB A (PMHNP)
Entity type:Individual
Prefix:
First Name:MINTWAB
Middle Name:A
Last Name:MANAYE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8749 W CORDES RD
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-8607
Mailing Address - Country:US
Mailing Address - Phone:602-460-1530
Mailing Address - Fax:
Practice Address - Street 1:1201 S 7TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-4075
Practice Address - Country:US
Practice Address - Phone:602-416-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ306438363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health