Provider Demographics
NPI:1720414923
Name:MANNING, JAMIE M (PA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:MANNING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:CATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:520 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1870
Mailing Address - Country:US
Mailing Address - Phone:616-523-1400
Mailing Address - Fax:616-523-1429
Practice Address - Street 1:550 E WASHINGTON ST
Practice Address - Street 2:STE 104
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-2202
Practice Address - Country:US
Practice Address - Phone:616-523-1586
Practice Address - Fax:616-523-1429
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006818363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant