Kimberly A Mancilla, SA-C

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

Practice address

1604 Visa Dr
Suite 1
Normal, IL 61761-2195

Phone

(309) 846-4716

Fax

(309) 454-1107

NPI assigned

Nov 18, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1290038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1588966840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 VISA DR STE 1",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612195",
            "telephone_number": "309-846-4716",
            "fax_number": "309-454-7348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 VISA DR",
            "address_2": "SUITE 1",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612195",
            "telephone_number": "309-846-4716",
            "fax_number": "309-454-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCILLA",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "SA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-18",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald Anton Maier, M.A., L.C.P.C.
• Karen L Major, L.C.S.W.
• Angela Malinowski
• Tara Malinowski
• Ajay R Malpani, M.D.
• Jenna Rose Forrest Mangold, LCSW
• Saravanakumar Manickam, MD
• Kimberlee Marisa Manieri, BCBA
• Shannon Marie Brieashia Marcum
• Diana Lee Mariani, MSW, LCSW

• Surgical Assistant in Normal, IL
• Providers in Normal, IL by specialty
• Surgical Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; 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.