Provider Demographics
NPI:1437236809
Name:MANNING, LORA LEIGH (CRNA)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:LEIGH
Last Name:MANNING
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3856
Mailing Address - Country:US
Mailing Address - Phone:207-329-2114
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9422
Practice Address - Country:US
Practice Address - Phone:207-283-7040
Practice Address - Fax:207-283-7850
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER035859367500000X
FL11000357367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430075429OtherRAILROAD MEDICARE
430075429OtherRAILROAD MEDICARE
MAMM6693Medicare ID - Type Unspecified