Healthcare Provider Details

I. General information

NPI: 1356834436
Provider Name (Legal Business Name): ZACHARIAH MANNING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 WAYSIDE LOOP
SPRINGFIELD OR
97477-1331
US

IV. Provider business mailing address

1755 COBURG RD UNIT 301
EUGENE OR
97401-4900
US

V. Phone/Fax

Practice location:
  • Phone: 541-746-5352
  • Fax:
Mailing address:
  • Phone: 458-256-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201709467RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number202107861NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: