Provider Demographics
NPI:1124141304
Name:MANSMANN, MONIKA WYGANOWSKA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MONIKA
Middle Name:WYGANOWSKA
Last Name:MANSMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:
Other - Last Name:WYGANOWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2325 HERITAGE CENTER DR STE 605
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1279
Mailing Address - Country:US
Mailing Address - Phone:215-874-4200
Mailing Address - Fax:215-918-8808
Practice Address - Street 1:2325 HERITAGE CENTER DR STE 605
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1279
Practice Address - Country:US
Practice Address - Phone:215-874-4200
Practice Address - Fax:215-918-8808
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062453207VG0400X
NJ25MP00147300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ140372C5WMedicare PIN