Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | APRN.CNP.0029115 | OH |
NPI | 1285204982 |
---|---|
Provider Name | Allison Nicole Mancz |
First Address | Centerville, OH 45459-2116 |
Second Address | Kettering, OH 45429-1265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2021 |
Last Update Date | 26/10/2021 |