Provider Demographics
NPI:1467001669
Name:MANLEY, JEANETTE
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:MANLEY
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 1:214 YELLOW HAMMER RD
Mailing Address - Street 2:
Mailing Address - City:TYNER
Mailing Address - State:NC
Mailing Address - Zip Code:27980-9662
Mailing Address - Country:US
Mailing Address - Phone:252-221-8922
Mailing Address - Fax:
Practice Address - Street 1:214 YELLOW HAMMER RD
Practice Address - Street 2:
Practice Address - City:TYNER
Practice Address - State:NC
Practice Address - Zip Code:27980-9662
Practice Address - Country:US
Practice Address - Phone:252-221-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider