Provider Demographics
NPI:1083952238
Name:MANCHESTER, CLAIRE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MARIE
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743752
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3752
Mailing Address - Country:US
Mailing Address - Phone:702-476-2800
Mailing Address - Fax:702-476-2040
Practice Address - Street 1:10652 S EASTERN AVE
Practice Address - Street 2:STE A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4952
Practice Address - Country:US
Practice Address - Phone:702-476-2800
Practice Address - Fax:702-476-2040
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA0259363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1083952238Medicaid
V109258OtherMEDICARE PTAN