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General NPI Number Information
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NPI Number | 1316040660
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Entity Type | Individual
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Provider Name | KATHERINE JANE MANZANARES
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Gender | Female
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 1800 NORTH BEAUREGARD STREET, SUITE 250
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City | ALEXANDRIA
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State | VA
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Zip | 22311-5879
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Country | US
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Telephone | 703-370-2400
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Fax | 703-370-7214
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Provider Business Mailing Address
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Address Line | 224-D CORNWALL STREET, NW, SUITE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA030510
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110003633
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License Number State | VA
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