Lacey Manimala

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

209030375 Issued in IL

Practice address

1026 Gunderson Ave
Oak Park, IL 60304-2118

Phone

(312) 509-1616

NPI assigned

Aug 20, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: lacey.manimala.1@13158.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• PCC Community Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1609892223
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1023840725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 GUNDERSON AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603042118",
            "telephone_number": "312-509-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 GUNDERSON AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603042118",
            "telephone_number": "312-509-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANIMALA",
        "first_name": "LACEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-20",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "IL",
            "license": "209030375",
            "primary": true
        },
        {
            "code": "163WX0002X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Obstetric, High-Risk",
            "state": "IL",
            "license": "041.447143",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malcolm a Deam MD & Associates SC
• Deisy Maldonado
• Ivy Fay Malisow, LCPC
• James Joseph Mancuso, LCPC
• Sabrina Gail Mandelbaum, M.A., CCC-SLP
• Aliya Manjarrez
• Janet Marie Mankoff
• Gayle Ann Mann, PSY.D.
• Sean Manning, D.C.
• David Manno, D.O.

• Advanced Practice Midwife in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Advanced Practice Midwife in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.