Healthcare Provider Details

I. General information

NPI: 1942759329
Provider Name (Legal Business Name): ELIZABETH JANE ROSS MANNING NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MARTIN LUTHER KING JR DR
WASHINGTON NC
27889-4906
US

IV. Provider business mailing address

120 W MARTIN LUTHER KING JR DR
WASHINGTON NC
27889-4906
US

V. Phone/Fax

Practice location:
  • Phone: 252-940-0602
  • Fax:
Mailing address:
  • Phone: 252-940-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009970
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174025
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: