Provider Demographics
NPI:1861635203
Name:MANNING, LATRIECE EILEENA (DO)
Entity Type:Individual
Prefix:
First Name:LATRIECE
Middle Name:EILEENA
Last Name:MANNING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-2919
Mailing Address - Country:US
Mailing Address - Phone:609-261-0240
Mailing Address - Fax:
Practice Address - Street 1:1617 ROUTE 38
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2919
Practice Address - Country:US
Practice Address - Phone:609-261-0240
Practice Address - Fax:609-261-8622
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08520000207V00000X
PAOS014622207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology