Nicole Ivonne McManus, DO
Student in an Organized Health Care Education/Training Program in Philadelphia, PA. Individual provider (NPI-1).
NPI number1770103400
StatusActive
Last updated in NPPESApr 22, 2020
Details
- NPI
- 1770103400
- Entity type
- Individual (NPI-1)
- Name
- Nicole Ivonne McManus
- Credential
- DO
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 22, 2020
- Certification date
- Apr 22, 2020
- Last updated
- Apr 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
4190 City Ave Ste 409Philadelphia, PA 19131-1629
Phone 352-459-7479
Mailing address
6872 Outrigger CtFlowery Branch, GA 30542-6622
Phone 352-459-7479
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