Individual
DR. STEPHANIE MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, DC, FICPA
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
5988
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0941110
BCBS
AZ
Enumeration date
03/15/2007
Last updated
01/07/2013
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