=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093696957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE JANETTE MANZANARES NURSING
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2025
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2003 CHISM DRIVE
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-250-1463
-----------------------------------------------------
Fax | 719-621-4974
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2003 CHISM DR
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81008-1869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-250-1463
-----------------------------------------------------
Fax | 719-621-4974
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
-----------------------------------------------------
License Number | 0082772
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------