Healthcare Provider Details

I. General information

NPI: 1104632397
Provider Name (Legal Business Name): LA'SHELLE MANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8912 FOOTED RDG
COLUMBIA MD
21045-4216
US

IV. Provider business mailing address

8912 FOOTED RDG
COLUMBIA MD
21045-4216
US

V. Phone/Fax

Practice location:
  • Phone: 240-488-6226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: