Provider Demographics
NPI:1730811837
Name:MANCHA, DANIA (FNP-BC)
Entity type:Individual
Prefix:
First Name:DANIA
Middle Name:
Last Name:MANCHA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 W KOFA PASS
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:AZ
Mailing Address - Zip Code:85539-9712
Mailing Address - Country:US
Mailing Address - Phone:928-200-3074
Mailing Address - Fax:
Practice Address - Street 1:285 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2503
Practice Address - Country:US
Practice Address - Phone:928-425-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily