Healthcare Provider Details

I. General information

NPI: 1164967568
Provider Name (Legal Business Name): ZJIA ANITA MANZANARES EVANS C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZJIA ANITA MANZANARES R.N.

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 07/21/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PINE RIDGE BLVD SUITE 211
WAUSAU WI
54401-4123
US

IV. Provider business mailing address

425 PINE RIDGE BLVD SUITE 211
WAUSAU WI
54401-4123
US

V. Phone/Fax

Practice location:
  • Phone: 715-845-5505
  • Fax: 715-848-2884
Mailing address:
  • Phone: 715-845-5505
  • Fax: 715-848-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number232331
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7457
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: