Provider Demographics
NPI:1255693685
Name:MANESS, CHRISTIAN COPELAND (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:COPELAND
Last Name:MANESS
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 1:1245 MILL RACE LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-2989
Mailing Address - Country:US
Mailing Address - Phone:704-698-5628
Mailing Address - Fax:
Practice Address - Street 1:1245 MILL RACE LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-2989
Practice Address - Country:US
Practice Address - Phone:704-698-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC214838163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult