Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | RN086518 | AZ |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 18325 | SC |
NPI | 1053394486 |
---|---|
Provider Name | Susan Mani |
First Address | Atlanta, GA 30374-3070 |
Second Address | Spartanburg, SC 29303-3040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 06/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
367690 | (05) | AZ |
NP2764 | (05) | SC |
S29869 | (02) | AZ |