Provider Demographics
NPI:1407547102
Name:MANNSORE, ANASIMON (AUD)
Entity Type:Individual
Prefix:
First Name:ANASIMON
Middle Name:
Last Name:MANNSORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GIBSON DR APT 934
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5788
Mailing Address - Country:US
Mailing Address - Phone:916-895-6733
Mailing Address - Fax:
Practice Address - Street 1:800 GIBSON DR APT 934
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5788
Practice Address - Country:US
Practice Address - Phone:916-895-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter