1639403926 NPI number — NANCY K MANTZ CRNP

Table of content: NANCY K MANTZ CRNP (NPI 1639403926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639403926 NPI number — NANCY K MANTZ CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANTZ
Provider First Name:
NANCY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639403926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16003-1549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-284-5670
Provider Business Mailing Address Fax Number:
724-284-4144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPITAL WAY
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16001-4670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-431-0550
Provider Business Practice Location Address Fax Number:
724-477-7208
Provider Enumeration Date:
09/21/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  UP006480W , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)