Provider Demographics
NPI:1467457622
Name:MANSY, CAROLINE G (FNP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:G
Last Name:MANSY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 BELMONT AVE UNIT 503
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4590
Mailing Address - Country:US
Mailing Address - Phone:443-978-3000
Mailing Address - Fax:855-274-7151
Practice Address - Street 1:1340 BELMONT AVE UNIT 503
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4590
Practice Address - Country:US
Practice Address - Phone:443-978-3000
Practice Address - Fax:855-274-7151
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN113099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412959800Medicaid
TN3905944Medicare ID - Type Unspecified
TNP05432Medicare UPIN