Provider Demographics
NPI:1710379730
Name:MANU, JESSICA HENRIETTA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HENRIETTA
Last Name:MANU
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 DERRINGER RDG
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5686
Mailing Address - Country:US
Mailing Address - Phone:347-439-0962
Mailing Address - Fax:
Practice Address - Street 1:1862 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-4163
Practice Address - Country:US
Practice Address - Phone:404-289-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33339508363LF0000X
MDAC001753363LF0000X
GARN262737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily