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General NPI Number Information
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NPI Number | 1467670059
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Entity Type | Individual
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Provider Name | NICOLE FELICE MANCHA M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 350 N GRANDVIEW AVE
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City | DUBUQUE
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State | IA
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Zip | 52001-6388
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Country | US
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Telephone | 563-589-2560
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Fax |
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Provider Business Mailing Address
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Address Line | 42 W VILLAGE CIR
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City | DAVENPORT
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State | IA
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Zip | 52806-4857
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Country | US
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Telephone | 563-386-5968
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 37128
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036.117369
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | N7942
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License Number State | TX
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