MEDICARE: VICTORIA ELIZABETH MCMANUS FNP-C

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
1	363LF0000X	Family Nurse Practitioner	346269	NY

General Provider Information

NPI Number	:	1063025724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA ELIZABETH MCMANUS FNP-C

Provider Business Mailing Address
First Line	:	365 HARRY L DR STE 110
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1471
Country	:	US
Telephone Number	:	607-729-5805
Fax Number	:	607-729-7714

Provider Business Practice Location Address
First Line	:	365 HARRY L DR STE 110
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1471
Country	:	US
Telephone Number	:	607-729-5805
Fax Number	:	607-729-7714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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