Healthcare Provider Details

I. General information

NPI: 1730953761
Provider Name (Legal Business Name): JONATHAN DOUGLAS MANLEY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W 53RD ST
DAVENPORT IA
52806-2459
US

IV. Provider business mailing address

1520 W 53RD ST
DAVENPORT IA
52806-2459
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-3840
  • Fax:
Mailing address:
  • Phone: 563-421-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA190443
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: