Provider Demographics
NPI:1801396130
Name:MANNING, TANISHA DENISE (BIRTH DOULA)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:DENISE
Last Name:MANNING
Suffix:
Gender:F
Credentials:BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2492
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93504-0492
Mailing Address - Country:US
Mailing Address - Phone:833-773-8895
Mailing Address - Fax:
Practice Address - Street 1:31 S SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-3211
Practice Address - Country:US
Practice Address - Phone:833-773-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner