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NPI Code Detail

MEDICARE: IAN B MANESS FNP

MEDICARE: IAN B MANESS FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP128003TX
2363LF0000XFamily Nurse Practitioner201506484NP-PPOR

General Provider Information

NPI Number : 1033594544
Entity Type Code : Individual
Provider Name (Legal Business Name) : IAN B MANESS FNP
Provider Business Mailing Address
First Line : PO BOX 1189
Second Line :
City : CORVALLIS
State : OR
Zip : 97339-1189
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 531 N HIGHWAY 101 STE A
Second Line :
City : DEPOE BAY
State : OR
Zip : 97341-9572
Country : US
Telephone Number : 541-765-3265
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2015
Last Update Date : 09/29/2023

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