Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5007862 | NC |
NPI | 1043284961 |
---|---|
Provider Name | Mr. John Thomas Manning |
First Address | Cedar Point, NC 28584-7209 |
Second Address | Cedar Point, NC 28584-7209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 22/09/2016 |