Provider Demographics
NPI:1265789796
Name:MCMANUS, RENEE LYNN (DNP PMHNP-BC ACNS-BC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:DNP PMHNP-BC ACNS-BC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:LYNN
Other - Last Name:TIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3888 NELSON MOSIER RD
Mailing Address - Street 2:
Mailing Address - City:LEAVITTSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44430-9424
Mailing Address - Country:US
Mailing Address - Phone:330-509-5099
Mailing Address - Fax:
Practice Address - Street 1:11369 MARKET ST
Practice Address - Street 2:
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452-9782
Practice Address - Country:US
Practice Address - Phone:330-965-9999
Practice Address - Fax:234-759-3971
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09915-NS364SA2200X
OHAPRN.CNP.0029986363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH77180Medicaid
OH$$$$$$$$$00OtherBUREAU OF WORKER'S COMPENSATION
OH$$$$$$$$$00OtherBUREAU OF WORKER'S COMPENSATION