Provider Demographics
NPI:1326583071
Name:MANZANO, JENAH WESLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:JENAH
Middle Name:WESLEY
Last Name:MANZANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WOLFSNARE LN
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7061
Mailing Address - Country:US
Mailing Address - Phone:561-376-5705
Mailing Address - Fax:
Practice Address - Street 1:410 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4861
Practice Address - Country:US
Practice Address - Phone:919-934-5149
Practice Address - Fax:919-934-5632
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06834363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant