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General NPI Number Information
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NPI Number | 1639403348
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Entity Type | Individual
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Provider Name | MICHAEL JAMES MANLEY FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 1306 STATE ST
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City | AUGUSTA
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State | KS
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Zip | 67010-1126
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Country | US
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Telephone | 316-775-9191
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Fax | 316-775-0348
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Provider Business Mailing Address
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Address Line | 875 S SAGEBRUSH CT
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City | WICHITA
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State | KS
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Zip | 67230-7663
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Country | US
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Telephone | 316-806-6707
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Fax | 316-337-5758
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5382453031
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License Number State | KS
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