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General NPI Number Information
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NPI Number | 1831530567
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Entity Type | Individual
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Provider Name | LAURIE ELLEN MANFRATES MSED
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Gender | Female
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 308 WESTMINSTER RD
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City | DE WITT
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State | NY
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Zip | 13214-1824
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Country | US
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Telephone | 315-445-2773
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Fax |
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Provider Business Mailing Address
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Address Line | 308 WESTMINSTER RD
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City | DE WITT
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State | NY
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Zip | 13214-1824
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Country | US
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Telephone |
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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 | 703375131
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 689735121
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 703280131
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 536563111
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 522587111
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License Number State | NY
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