Individual
MICHELLE AUDREY MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA09122
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8621NZ
BCBS - XCITE SURGICAL
TX
01
—
8945NY
BCBS - UNIVERSAL SURGICAL PARTNERS
TX
Enumeration date
05/22/2014
Last updated
06/11/2019
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