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Individual

MRS. DEANNA MARIE MANTLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5581
(573) 632-5876
Mailing address
1716 HIGHWAY C, BONNOTS MILL, MO 65016-2104

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2008020776
MO

Other

Enumeration date
02/20/2015
Last updated
02/20/2015
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