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NPI Code Detail

MEDICARE: HEATHER F MANNOR P.A.-C

MEDICARE: HEATHER F MANNOR P.A.-C
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 Assistant5601002365MI

General Provider Information

NPI Number : 1497722870
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER F MANNOR P.A.-C
Provider Business Mailing Address
First Line : 2749 BIRCHWOOD DR
Second Line :
City : HOWELL
State : MI
Zip : 48855-7645
Country : US
Telephone Number : 517-545-2512
Fax Number :
Provider Business Practice Location Address
First Line : 102 N ADELAIDE ST
Second Line :
City : FENTON
State : MI
Zip : 48430-2670
Country : US
Telephone Number : 810-629-2245
Fax Number : 810-629-6535
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2006
Last Update Date : 07/09/2007

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Directions to “ HEATHER F MANNOR P.A.-C” Practice Location

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