Provider Demographics
NPI:1194990366
Name:MANTHE, MICHELLE LEE (PAC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEE
Last Name:MANTHE
Suffix:
Gender:F
Credentials:PAC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1615 W PERSIMMON ST STE B
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3383
Mailing Address - Country:US
Mailing Address - Phone:479-636-7192
Mailing Address - Fax:479-631-8212
Practice Address - Street 1:5320 W SUNSET AVE STE 157
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4410
Practice Address - Country:US
Practice Address - Phone:479-966-7331
Practice Address - Fax:855-618-2364
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPA 401363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical