Provider Demographics
NPI:1295051233
Name:MANLEY, NATALIE ANN (MD, MPH)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ANN
Last Name:MANLEY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:ANN
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:402-559-9600
Mailing Address - Fax:402-559-8228
Practice Address - Street 1:988102 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-8102
Practice Address - Country:US
Practice Address - Phone:402-559-9600
Practice Address - Fax:402-559-9586
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE28487207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program