Healthcare Provider Details

I. General information

NPI: 1730811837
Provider Name (Legal Business Name): DANIA MANCHA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 N BROAD ST
GLOBE AZ
85501-2503
US

IV. Provider business mailing address

285 N BROAD ST
GLOBE AZ
85501-2503
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-8200
  • Fax: 928-425-8406
Mailing address:
  • Phone: 928-425-8200
  • Fax: 928-425-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27652
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: