| Doctor Name: | DR. IMMACULADA MANZANARES DECENA |
| NPI Number: | 1093850646 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 4-16250 |
| Business Practice Address: | 711 Marshall St Cushing Hopsital Emergency Department Leavenworth, KS - 660483235 |
| Business Phone Number: | 9136821144 |
| Business Fax Number: | 9136841273 |
| Mailing Address: | Po Box 1675, LEAVENWORTH |
| State: | KS |
| Postal Code: | 660480675 |
| Phone Number: | 9132500468 |
| Fax Number: | 9137272415 |
| NPI Enumeration Date: | 02/21/2007 |
| NPI Last Update Date: | 09/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207PE0004X |
| License Number: | 4-16250 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Emergency Medicine |
| Taxonomy Specialization: | Emergency Medical Services |
| Taxonomy Definition: | An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |