Healthcare Provider Details

I. General information

NPI: 1265789796
Provider Name (Legal Business Name): RENEE LYNN MCMANUS DNP PMHNP-BC ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE LYNN TIDD

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11369 MARKET ST
NORTH LIMA OH
44452-9782
US

IV. Provider business mailing address

3888 NELSON MOSIER RD
LEAVITTSBURG OH
44430-9424
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 234-759-3971
Mailing address:
  • Phone: 330-509-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCOA.09915-NS
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0029986
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: