Provider Demographics
NPI:1609137736
Name:MCMANUS, MARISSA LA'SHAE (CD)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:LA'SHAE
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 SHELTON BEACH RD APT 40
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3040
Mailing Address - Country:US
Mailing Address - Phone:251-300-0646
Mailing Address - Fax:
Practice Address - Street 1:807 SHELTON BEACH RD APT 40
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-3040
Practice Address - Country:US
Practice Address - Phone:251-300-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula