Provider Demographics
NPI:1205805223
Name:MCMANUS, PAULA BROCK (ARNP)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:BROCK
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1003 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3502
Mailing Address - Country:US
Mailing Address - Phone:515-267-1003
Mailing Address - Fax:515-267-0100
Practice Address - Street 1:1003 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3502
Practice Address - Country:US
Practice Address - Phone:515-267-1003
Practice Address - Fax:515-267-0100
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA053214163WP0807X
IAZ053214363LP0808X, 364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
INIA0118OtherJOHN DEERE HC
IA40827OtherBLUE SHIELD
IA1045898Medicaid
IA1045898Medicaid