Provider Demographics
NPI:1689908089
Name:MANOR, VERONICA ANN (RN)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ANN
Last Name:MANOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MANOR STREET
Mailing Address - Street 2:
Mailing Address - City:RECLUSE
Mailing Address - State:WY
Mailing Address - Zip Code:82725-0027
Mailing Address - Country:US
Mailing Address - Phone:307-682-9884
Mailing Address - Fax:
Practice Address - Street 1:25 MANOR ST
Practice Address - Street 2:
Practice Address - City:RECLUSE
Practice Address - State:WY
Practice Address - Zip Code:82725-0027
Practice Address - Country:US
Practice Address - Phone:307-682-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY21802163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical