Provider Demographics
NPI:1952592370
Name:MANCIET, LORRAINE HANNA (MD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:HANNA
Last Name:MANCIET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 N SILVERBELL RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-5308
Mailing Address - Country:US
Mailing Address - Phone:520-744-3952
Mailing Address - Fax:520-744-2860
Practice Address - Street 1:395 N SILVERBELL RD
Practice Address - Street 2:#355
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2675
Practice Address - Country:US
Practice Address - Phone:520-622-5912
Practice Address - Fax:520-791-2246
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ552903Medicaid