Healthcare Provider Details

I. General information

NPI: 1073381562
Provider Name (Legal Business Name): CYNTHIA J MANTEY APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA CASKEY

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KNIK GOOSE BAY RD
WASILLA AK
99654-8083
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-631-7800
  • Fax:
Mailing address:
  • Phone: 907-729-7269
  • Fax: 907-729-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14835-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number229901
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: