Provider Demographics
NPI:1487657201
Name:MANSKER, LINDA M (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:MANSKER
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 1:566 POWERS DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4434
Mailing Address - Country:US
Mailing Address - Phone:916-939-3658
Mailing Address - Fax:919-939-3690
Practice Address - Street 1:2370 E BIDWELL ST
Practice Address - Street 2:STE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3892
Practice Address - Country:US
Practice Address - Phone:916-983-0550
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408197367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN4081970OtherMEDICAL
CAZZZ30433ZMedicare ID - Type Unspecified