Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP05317 | LA |
NPI | 1013114164 |
---|---|
Provider Name | Craig W Manzer |
First Address | Alexandria, LA 71301-3984 |
Second Address | Lafayette, LA 70508-6950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1348406 | (05) | LA |