MEDICARE: MRS. ANITA RAE MANNS NP-C, DNP, PMHNP-BC

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	363LA2200X	Adult Health Nurse Practitioner	4704225569	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704225569	MI

General Provider Information

NPI Number	:	1811177819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANITA RAE MANNS NP-C, DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	33228 W 12 MILE RD STE 154
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-3309
Country	:	US
Telephone Number	:	734-767-0165
Fax Number	:	248-487-1035

Provider Business Practice Location Address
First Line	:	33228 W 12 MILE RD
Second Line	:	STE 154
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-3309
Country	:	US
Telephone Number	:	734-767-0165
Fax Number	:	248-487-1035

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

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	06/24/2025

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