Healthcare Provider Details

I. General information

NPI: 1437236809
Provider Name (Legal Business Name): LORA LEIGH MANNING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
BIDDEFORD ME
04005-9422
US

IV. Provider business mailing address

1009 MORGAN ST
FORT COLLINS CO
80524-3856
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-7040
  • Fax: 207-283-7850
Mailing address:
  • Phone: 207-329-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR035859
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11000357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: