| Doctor Name: | MICHELLE MANOS |
| NPI Number: | 1760539746 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 9305 |
| Business Practice Address: | 2600 39th Ave Ne St Anthony, MN - 55421 |
| Business Phone Number: | 6127062980 |
| Business Fax Number: | 6127062981 |
| Mailing Address: | 2000 Plymouth Rd Ste 250, MINNETONKA |
| State: | MN |
| Postal Code: | 553052376 |
| Phone Number: | 9527672326 |
| Fax Number: | 9525935187 |
| NPI Enumeration Date: | 01/04/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 9305 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |