Provider Demographics
NPI:1386822807
Name:MANNING, LORETTA ANN
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:ANN
Last Name:MANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 POOSPATUCK LN
Mailing Address - Street 2:P.O. BOX 551
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-5223
Mailing Address - Country:US
Mailing Address - Phone:631-281-7472
Mailing Address - Fax:
Practice Address - Street 1:35 LONGWOOD RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2045
Practice Address - Country:US
Practice Address - Phone:631-924-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128383-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse