Individual
DERK LEE MANISCALCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP
Contact information
Practice address
700 NE 87TH AVE, VANCOUVER, WA 98664
(360) 397-3460
(360) 604-1761
Mailing address
15409 NE 89TH ST., VANCOUVER, WA 98682-0000
(303) 229-2418
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
201050075NP
OR
363LF0000X
Family Nurse Practitioner
Primary
AP60147803
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467764647
—
WA
Enumeration date
07/05/2010
Last updated
10/29/2019
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