Provider Demographics
NPI:1033367842
Name:MANYARA, SUSAN WANGECI (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:WANGECI
Last Name:MANYARA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 KINGS GIFT DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2032
Mailing Address - Country:US
Mailing Address - Phone:410-531-8490
Mailing Address - Fax:
Practice Address - Street 1:10 NORTH GREENE STREET
Practice Address - Street 2:BALTIMOR VA MEDICAL CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR107884163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine