Provider Demographics
NPI:1366761330
Name:MANTEUFEL, TAMMY (RN)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:
Last Name:MANTEUFEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1134
Mailing Address - Country:US
Mailing Address - Phone:920-725-1116
Mailing Address - Fax:
Practice Address - Street 1:1476 KENWOOD DR
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1134
Practice Address - Country:US
Practice Address - Phone:920-725-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174471163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse