Provider Demographics
NPI:1629734611
Name:MANERA, JUSTINE G
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:G
Last Name:MANERA
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 1:91-833 AIKANAKA RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2519
Mailing Address - Country:US
Mailing Address - Phone:808-386-0535
Mailing Address - Fax:808-689-3965
Practice Address - Street 1:91-833 AIKANAKA RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2519
Practice Address - Country:US
Practice Address - Phone:808-386-0535
Practice Address - Fax:808-689-3965
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty