Provider Demographics
NPI:1134782782
Name:MANNING, DEREK W (RN)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:W
Last Name:MANNING
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-1737
Mailing Address - Country:US
Mailing Address - Phone:248-763-5903
Mailing Address - Fax:
Practice Address - Street 1:304 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1737
Practice Address - Country:US
Practice Address - Phone:248-763-5903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704350364163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse