Provider Demographics
NPI:1568554194
Name:MANUSIA, CATHLEEN WOMBLE (FNP)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:WOMBLE
Last Name:MANUSIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:
Other - Last Name:WOMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:437 N EUCLID AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3456
Mailing Address - Country:US
Mailing Address - Phone:909-988-2555
Mailing Address - Fax:909-988-4447
Practice Address - Street 1:437 N EUCLID AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3456
Practice Address - Country:US
Practice Address - Phone:909-988-2555
Practice Address - Fax:909-988-4447
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13818363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner