Provider Demographics
NPI:1669672697
Name:MANZOEILLO, DALE ANN (NP)
Entity type:Individual
Prefix:MS
First Name:DALE
Middle Name:ANN
Last Name:MANZOEILLO
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2702 N 3RD ST STE 4020
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4608
Mailing Address - Country:US
Mailing Address - Phone:602-323-3492
Mailing Address - Fax:602-323-3399
Practice Address - Street 1:4315 N MARYVALE PKWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1942
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:623-691-1770
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2016-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAP2462363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11774490OtherCAQH
AZ230765Medicaid
AZ11774490OtherCAQH