Provider Demographics
NPI:1164570321
Name:MANNING, BARBARA A (NP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:A
Last Name:MANNING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:819 WORCESTER STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1001
Mailing Address - Country:US
Mailing Address - Phone:978-774-7566
Mailing Address - Fax:
Practice Address - Street 1:75 SYLVAN ST
Practice Address - Street 2:SUITE B-102
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2763
Practice Address - Country:US
Practice Address - Phone:978-774-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173085363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0719048Medicaid
MA000721701Medicare UPIN