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General NPI Number Information
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NPI Number | 1518736180
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Entity Type | Individual
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Provider Name | JENEL MANUEL
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Gender | Female
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Dates
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Enumeration Date | 12/25/2023
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 1708 FALL HILL AVE
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3511
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Country | US
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Telephone | 562-405-9844
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Fax |
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Provider Business Mailing Address
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Address Line | 825 FAIRFAX AVE
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City | NORFOLK
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State | VA
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Zip | 23507-1914
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Country | US
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Telephone | 757-446-5600
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 0110010309
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 0110010309
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110010309
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License Number State | VA
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