Provider Demographics
NPI:1649212655
Name:MANLOVE, TERESA M (CNM)
Entity Type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:M
Last Name:MANLOVE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:100 BREWSTER BLVD
Mailing Address - Street 2:CAMP LEJEUNE, NC
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2538
Mailing Address - Country:US
Mailing Address - Phone:910-450-4159
Mailing Address - Fax:910-450-4194
Practice Address - Street 1:1718 S INGRAM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7505
Practice Address - Country:US
Practice Address - Phone:660-827-0015
Practice Address - Fax:660-827-5490
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA111249367A00000X
MORN2009012360367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife