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General NPI Number Information
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NPI Number | 1134734296
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Entity Type | Individual
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Provider Name | CHRISTI MARYJO MANNOS RDH
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 10655 PROFESSIONAL CIR STE A
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City | RENO
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State | NV
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Zip | 89521-5840
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Country | US
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Telephone | 775-750-2173
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Fax |
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Provider Business Mailing Address
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Address Line | 10714 VISTA BONITA LN
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City | RENO
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State | NV
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Zip | 89521-4128
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Country | US
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Telephone | 775-750-2173
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 102015
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License Number State | NV
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