Individual
LANCE MANTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, CRNA
Contact information
Practice address
1101 9TH ST N, ESSENTIA HEALTH VIRGINIA CLINIC, VIRGINIA, MN 55792-2329
(218) 741-0150
Mailing address
1101 9TH ST N, ESSENTIA HEALTH VIRGINIA CLINIC, VIRGINIA, MN 55792-2329
(218) 741-0150
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R196774-4
MN
Other
Enumeration date
01/09/2015
Last updated
12/02/2015
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