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General NPI Number Information
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NPI Number | 1346779626
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Entity Type | Individual
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Provider Name | JILLIAN MANNG AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11000 N. SCOTTSDALE RD. #145
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City | SCOTTSDALE
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State | AZ
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Zip | 85254
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Country | US
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Telephone | 480-607-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 11000 N SCOTTSDALE RD STE 145
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5102
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Country | US
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Telephone | 480-607-0606
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP10152
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License Number State | AZ
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