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General NPI Number Information
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NPI Number | 1194990366
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Entity Type | Individual
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Provider Name | MICHELLE LEE MANTHE P.A.C.
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Gender | Female
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 5320 W SUNSET AVE STE 157
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City | SPRINGDALE
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State | AR
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Zip | 72762-4410
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Country | US
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Telephone | 479-966-7331
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Fax | 855-618-2364
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Provider Business Mailing Address
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Address Line | 1615 W PERSIMMON ST STE B
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City | ROGERS
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State | AR
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Zip | 72756-3383
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Country | US
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Telephone | 479-636-7192
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Fax | 479-631-8212
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 401
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License Number State | AR
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