MEDICARE: ALLISON ELIZABETH MANWEILER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1578453742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON ELIZABETH MANWEILER PA-C

Provider Business Mailing Address
First Line	:	7900 E PRINCESS DR APT 2158
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-5817
Country	:	US
Telephone Number	:	281-520-7214
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 E BASELINE RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6589
Country	:	US
Telephone Number	:	602-243-7277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	07/08/2025

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