Healthcare Provider Details

I. General information

NPI: 1184161259
Provider Name (Legal Business Name): MARIANA GABRIELA MANESCU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 S VERSHIRE CIR
MAGNOLIA TX
77354
US

IV. Provider business mailing address

155 S VERSHIRE CIR
MAGNOLIA TX
77354-3299
US

V. Phone/Fax

Practice location:
  • Phone: 586-718-4320
  • Fax:
Mailing address:
  • Phone: 586-718-4320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704250699
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704250699
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP145012
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: