MEDICARE: MR. JEFFERY LYNN MANNING F-NP

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	5074276-4405	UT

General Provider Information

NPI Number	:	1376796771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFERY LYNN MANNING F-NP

Provider Business Mailing Address
First Line	:	1396 N 4800 W
Second Line	:
City	:	PLAIN CITY
State	:	UT
Zip	:	84404-9489
Country	:	US
Telephone Number	:	801-731-7227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1396 N 4800 W
Second Line	:
City	:	PLAIN CITY
State	:	UT
Zip	:	84404-9489
Country	:	US
Telephone Number	:	801-731-7227
Fax Number	:

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

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	04/16/2009

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