Provider Demographics
NPI:1396368189
Name:MCMANUS, KATHARINE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14174-9778
Mailing Address - Country:US
Mailing Address - Phone:585-944-6810
Mailing Address - Fax:
Practice Address - Street 1:6137 JIBWAY CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-2909
Practice Address - Country:US
Practice Address - Phone:585-944-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPA58513363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program