Antonette Manigsaca

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61616863 Issued in WA

Practice address

605 Woodland Square Loop SE
Lacey, WA 98503-1045

Phone

(360) 764-8400

NPI assigned

Jun 25, 2024

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

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vest Thurston LLCGroup PAC ID 0648512459, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Vest Thurston LLC

  • Psychiatric Hospital
  • Lacey, WA
  • NPI 1336605849
  Medicare reassignment Care Compare group NPD
• Raphael Recovery and Support LLC

  • Psychiatry Physician
  • Olympia, WA
  • NPI 1578375879
  Medicare reassignment NPD

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

{
    "created_epoch": "1719273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1609610484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 WOODLAND SQUARE LOOP SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031045",
            "telephone_number": "360-764-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 WOODLAND SQUARE LOOP SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031045",
            "telephone_number": "360-764-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANIGSACA",
        "first_name": "ANTONETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-25",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61616863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Malcom
• Alyssa Maldonado
• Patrick William Maley
• Alika Malmstrom, LMP
• Manassehs Adult Family Home LLC
• Manitou Horizons LLC
• Myhre Manning-Kniestedt
• Manor Care of Lacey Wa, Association
• Stacy L Manroe, PA-C
• Jessica L Manzanares

• Psychiatric/Mental Health Nurse Practitioner in Lacey, WA
• Providers in Lacey, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.