Provider Demographics
NPI:1598881443
Name:MANUS, TONYA PENLAND
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:PENLAND
Last Name:MANUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2478 OLD POND DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-6109
Mailing Address - Country:US
Mailing Address - Phone:704-732-0785
Mailing Address - Fax:
Practice Address - Street 1:767 W 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-4238
Practice Address - Country:US
Practice Address - Phone:828-465-3928
Practice Address - Fax:828-465-3118
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care