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NPI Code Detail

MEDICARE: JERRICA MANAWAY

MEDICARE: JERRICA MANAWAY
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
1103K00000XBehavior Analyst2104134086NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093159345
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRICA MANAWAY
Provider Business Mailing Address
First Line : 720 W CHEYENNE AVE #30
Second Line :
City : LAS VEGAS
State : NV
Zip : 89030-8717
Country : US
Telephone Number : 702-487-5665
Fax Number :
Provider Business Practice Location Address
First Line : 720 W CHEYENNE AVE STE 30
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7817
Country : US
Telephone Number : 702-487-5665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2013
Last Update Date : 04/17/2013

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Directions to “ JERRICA MANAWAY ” Practice Location

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