MEDICARE: CHRISTINA MANIS FNP

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	95018197	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95018197	OTHER	CA	BOARD OF NURSING

General Provider Information

NPI Number	:	1477216174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MANIS FNP

Provider Business Mailing Address
First Line	:	5150 MAE ANNE AVE STE 405
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89523-1859
Country	:	US
Telephone Number	:	916-532-6305
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 MAE ANNE AVE STE 405
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89523-1859
Country	:	US
Telephone Number	:	916-532-6305
Fax Number	:

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

Provider Enumeration Date	:	10/19/2021
Last Update Date	:	05/27/2023

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