Healthcare Provider Details

I. General information

NPI: 1962686014
Provider Name (Legal Business Name): ASHLEY DAWN MANNING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY DAWN BATESOLE PA-C

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 130
COEUR D ALENE ID
83814-4404
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-4700
  • Fax: 208-625-4701
Mailing address:
  • Phone: 208-625-4700
  • Fax: 208-625-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2048
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01422
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: