Provider Demographics
NPI:1598384653
Name:MANNING, KAREN A (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:MANNING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19992 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6004
Mailing Address - Country:US
Mailing Address - Phone:714-319-8818
Mailing Address - Fax:
Practice Address - Street 1:2045 MEYER PL
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2967
Practice Address - Country:US
Practice Address - Phone:949-515-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399050163WS0200X, 364SP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics