Healthcare Provider Details

I. General information

NPI: 1104734722
Provider Name (Legal Business Name): MANSKE MOBILE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 N BEACH RD
EASTSOUND WA
98245-8914
US

IV. Provider business mailing address

PO BOX 31
EASTSOUND WA
98245-0031
US

V. Phone/Fax

Practice location:
  • Phone: 505-501-2839
  • Fax:
Mailing address:
  • Phone: 505-501-2839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PROF. JENNIFER SIMPSON-MANSKE
Title or Position: PHYSICIAN
Credential: MD
Phone: 505-501-2839