Provider Demographics
NPI:1255581112
Name:MACMANUS, LAURA A (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:MACMANUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:A
Other - Last Name:VANSTRALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:11398
Mailing Address - Street 1:33675 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2122
Mailing Address - Country:US
Mailing Address - Phone:909-795-4735
Mailing Address - Fax:
Practice Address - Street 1:264 N HIGHLAND SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3082
Practice Address - Country:US
Practice Address - Phone:951-845-6993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11398363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner