MEDICARE: MRS. MICHELLE MARGARET MANTERNACH ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	A132237	IA
2	363LF0000X	Family Nurse Practitioner	A132237	IA

General Provider Information

NPI Number	:	1356824072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE MARGARET MANTERNACH ARNP

Provider Business Mailing Address
First Line	:	200 HAWKINS DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1009
Country	:	US
Telephone Number	:	319-384-8822
Fax Number	:	319-467-1002

Provider Business Practice Location Address
First Line	:	1632 SYCAMORE ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240
Country	:	US
Telephone Number	:	319-384-8822
Fax Number	:	319-467-1002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2018
Last Update Date	:	10/08/2019

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