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General NPI Number Information
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NPI Number | 1881914927
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Entity Type | Individual
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Provider Name | MANDY REBECCA MANESS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 2390 W CONGRESS ST
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City | LAFAYETTE
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State | LA
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Zip | 70506-4205
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Country | US
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Telephone | 337-261-6179
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Fax |
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Provider Business Mailing Address
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Address Line | 131 TECHE DR
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City | LAFAYETTE
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State | LA
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Zip | 70503-2537
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Country | US
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Telephone | 504-250-6263
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD.306551
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License Number State | LA
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