Healthcare Provider Details

I. General information

NPI: 1982436093
Provider Name (Legal Business Name): MARNI NOEL MCMANUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARNI NOEL SCANLON

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX 1600
FPO AP
96362-0017
US

IV. Provider business mailing address

17 BALTIMORE ST
LYNN MA
01902-3205
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: