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General NPI Number Information
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NPI Number | 1336891068
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Entity Type | Individual
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Provider Name | LAURA MARY MANIFF RD
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Gender | Female
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 1520 SUDAY DRIVE STE 309
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City | RALEIGH
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State | NC
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Zip | 27607-1000
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Country | US
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Telephone | 919-354-7077
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Fax |
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Provider Business Mailing Address
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Address Line | 10208 CERNY ST STE 301
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City | RALEIGH
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State | NC
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Zip | 27617-1000
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Country | US
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Telephone | 919-354-7077
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | L005878
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License Number State | NC
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