Healthcare Provider Details

I. General information

NPI: 1114836343
Provider Name (Legal Business Name): RACHEL IVANA MANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 APEX HWY 102
DURHAM NC
27713
US

IV. Provider business mailing address

5105 STARDUST DRIVE
DURHAM NC
27712-9537
US

V. Phone/Fax

Practice location:
  • Phone: 919-599-7265
  • Fax:
Mailing address:
  • Phone: 919-923-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5025373
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: