Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 124024 | CA |
Y | 207N00000X | Dermatologist | 17469 | NV |
NPI | 1023300977 |
---|---|
Provider Name | Irene Helen Mannering |
First Address | Reno, NV 89509-4903 |
Second Address | Sparks, NV 89436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2011 |
Last Update Date | 21/09/2018 |