Provider Demographics
NPI:1942759329
Name:MANNING, ELIZABETH JANE ROSS (NP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE ROSS
Last Name:MANNING
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4906
Mailing Address - Country:US
Mailing Address - Phone:252-940-0602
Mailing Address - Fax:
Practice Address - Street 1:120 W MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4906
Practice Address - Country:US
Practice Address - Phone:252-940-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009970363L00000X
VA0024174025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily