Provider Demographics
NPI:1619284924
Name:MANKE, DEBORAH L (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:MANKE
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 1:250 MATHIS FERRY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2988
Mailing Address - Country:US
Mailing Address - Phone:843-469-1001
Mailing Address - Fax:
Practice Address - Street 1:250 MATHIS FERRY RD
Practice Address - Street 2:STE 101
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2988
Practice Address - Country:US
Practice Address - Phone:843-469-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004320363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health