MEDICARE: IRECA ANN MANCE

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	363A00000X	Physician Assistant	PA17900	TX

General Provider Information

NPI Number	:	1871226589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRECA ANN MANCE

Provider Business Mailing Address
First Line	:	PO BOX 731263
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-6926
Country	:	US
Telephone Number	:	214-884-4700
Fax Number	:	214-884-4761

Provider Business Practice Location Address
First Line	:	6407 CARLTON GARRETT STREET
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215
Country	:	US
Telephone Number	:	214-833-3478
Fax Number	:	214-833-3491

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

Provider Enumeration Date	:	07/08/2022
Last Update Date	:	06/18/2026

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Directions to “ IRECA ANN MANCE ” Practice Location

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