Provider Demographics
NPI:1326816059
Name:MANSPEAKER, LILANYA (OFMT)
Entity Type:Individual
Prefix:
First Name:LILANYA
Middle Name:
Last Name:MANSPEAKER
Suffix:
Gender:F
Credentials:OFMT
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:MANSPEAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6908 MIRABEL RD
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-9678
Mailing Address - Country:US
Mailing Address - Phone:707-849-3002
Mailing Address - Fax:
Practice Address - Street 1:6908 MIRABEL RD
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:CA
Practice Address - Zip Code:95436-9678
Practice Address - Country:US
Practice Address - Phone:707-849-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty