Provider Demographics
NPI:1205804762
Name:MCMANUS, JACALYN A (NP)
Entity type:Individual
Prefix:
First Name:JACALYN
Middle Name:A
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LEWIS BAY RD
Mailing Address - Street 2:PRIMARY CARE INTERNISTS
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-862-5560
Mailing Address - Fax:508-771-7321
Practice Address - Street 1:22 LEWIS BAY RD
Practice Address - Street 2:PRIMARY CARE INTERNISTS
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-862-5560
Practice Address - Fax:508-771-7321
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA134161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP0264OtherBCBS
NP0264Medicare ID - Type Unspecified
S57761Medicare UPIN