Provider Demographics
NPI:1497535363
Name:MANFRA, EMILY (AGNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MANFRA
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 POND ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2840
Mailing Address - Country:US
Mailing Address - Phone:781-568-9664
Mailing Address - Fax:
Practice Address - Street 1:23 WARREN AVE STE 100
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4983
Practice Address - Country:US
Practice Address - Phone:781-933-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2363270363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care