Provider Demographics
NPI:1205028545
Name:MANLEY, TONIA LYNN (NURSING)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:LYNN
Last Name:MANLEY
Suffix:
Gender:F
Credentials:NURSING
Other - Prefix:
Other - First Name:TONIA
Other - Middle Name:LYNN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSING
Mailing Address - Street 1:2830 CRANBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-6503
Mailing Address - Country:US
Mailing Address - Phone:253-226-0125
Mailing Address - Fax:
Practice Address - Street 1:38TH STREET BUILDING 38707
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30815
Practice Address - Country:US
Practice Address - Phone:706-787-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00050337164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse