Provider Demographics
NPI:1770302176
Name:MANLEY, MONICA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MANLEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PROSPECT ST APT B101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-5633
Mailing Address - Country:US
Mailing Address - Phone:314-599-2099
Mailing Address - Fax:
Practice Address - Street 1:24499 SW GRAHAMS FERRY RD
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7523
Practice Address - Country:US
Practice Address - Phone:503-570-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10026613363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health