Provider Demographics
NPI:1841793437
Name:MANNING, SHAWNYA MARIE (LPT)
Entity Type:Individual
Prefix:
First Name:SHAWNYA
Middle Name:MARIE
Last Name:MANNING
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 MCMILLAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6766
Mailing Address - Country:US
Mailing Address - Phone:805-439-9890
Mailing Address - Fax:
Practice Address - Street 1:2945 MCMILLAN AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6766
Practice Address - Country:US
Practice Address - Phone:805-439-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34044167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician