Provider Demographics
NPI:1356834436
Name:MANNING, ZACHARIAH
Entity Type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:
Last Name:MANNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 COBURG RD UNIT 301
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4900
Mailing Address - Country:US
Mailing Address - Phone:458-256-0206
Mailing Address - Fax:
Practice Address - Street 1:3024 WAYSIDE LOOP
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1331
Practice Address - Country:US
Practice Address - Phone:541-746-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201709467RN163W00000X
OR202107861NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202107861NP-PPOtherOREGON STATE BOARD OF NURSING