Provider Demographics
NPI:1356529630
Name:MANSON, SALLY JOANNE (RN)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:JOANNE
Last Name:MANSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SALLY
Other - Middle Name:JOANNE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:0
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-0781
Mailing Address - Country:US
Mailing Address - Phone:937-231-3125
Mailing Address - Fax:
Practice Address - Street 1:890 GEARHARDT LN
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-8619
Practice Address - Country:US
Practice Address - Phone:937-231-3125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH163W00000X163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse