MEDICARE: MARY NEUSCH MANN GNP

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	363LG0600X	Gerontology Nurse Practitioner	534263	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00230208	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8N7511	OTHER	TX	BCBS TEXAS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164446035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY NEUSCH MANN GNP

Provider Business Mailing Address
First Line	:	1108 LAVACA ST
Second Line	:	SUITE 110-320
City	:	AUSTIN
State	:	TX
Zip	:	78701-2172
Country	:	US
Telephone Number	:	512-477-4088
Fax Number	:	512-482-0390

Provider Business Practice Location Address
First Line	:	1108 LAVACA ST
Second Line	:	SUITE 110-320
City	:	AUSTIN
State	:	TX
Zip	:	78701-2172
Country	:	US
Telephone Number	:	512-477-4088
Fax Number	:	512-482-0390

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/20/2014

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