Provider Demographics
NPI:1386191500
Name:MANESS, TARASUE C (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TARASUE
Middle Name:C
Last Name:MANESS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TARASUE
Other - Middle Name:C
Other - Last Name:MEIKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-302-3760
Mailing Address - Fax:208-302-3768
Practice Address - Street 1:4424 E FLAMINGO AVE
Practice Address - Street 2:STE 310
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687
Practice Address - Country:US
Practice Address - Phone:208-302-3760
Practice Address - Fax:208-302-3768
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57594363LF0000X
WAAP60700086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily