Healthcare Provider Details

I. General information

NPI: 1548088024
Provider Name (Legal Business Name): NADINE NELSON MANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W PARK AVE
SANTA MARIA CA
93458-6116
US

IV. Provider business mailing address

1041 VISTA DEL MAR PL APT 107
VENTURA CA
93001-3776
US

V. Phone/Fax

Practice location:
  • Phone: 805-729-5613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: