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NPI Code Detail

MEDICARE: LISA NICOLE MANNING PA

MEDICARE: LISA NICOLE MANNING PA
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
1363A00000XPhysician AssistantPA6689MA

General Provider Information

NPI Number : 1164904579
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA NICOLE MANNING PA
Provider Business Mailing Address
First Line : 440 FOLEY ST
Second Line :
City : SOMERVILLE
State : MA
Zip : 02145-1213
Country : US
Telephone Number : 857-282-0777
Fax Number :
Provider Business Practice Location Address
First Line : 1285 BEACON ST
Second Line :
City : BROOKLINE
State : MA
Zip : 02446-5237
Country : US
Telephone Number : 617-751-6205
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2018
Last Update Date : 10/18/2022

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Directions to “ LISA NICOLE MANNING PA” Practice Location

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