Provider Demographics
NPI:1316589963
Name:MANLUCU, ZACHARY A (NP)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:A
Last Name:MANLUCU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:ZACHARY-ALLEN
Other - Middle Name:DANNUG
Other - Last Name:MANLUCU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8518 AUTUMN GRAIN GATE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5883
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 KAMEHAMEHA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2831
Practice Address - Country:US
Practice Address - Phone:808-969-7378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2828363L00000X
MDR210225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner