Provider Demographics
NPI:1235573247
Name:MANZARA, LAUREN RENEE (C-ANP)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:RENEE
Last Name:MANZARA
Suffix:
Gender:F
Credentials:C-ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 STAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2749
Mailing Address - Country:US
Mailing Address - Phone:630-935-0128
Mailing Address - Fax:
Practice Address - Street 1:580 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2749
Practice Address - Country:US
Practice Address - Phone:630-935-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009062363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health