Provider Demographics
NPI:1639469760
Name:MANZER, ANDREA K (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:MANZER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:K
Other - Last Name:LAMERAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:BAD RIVER CLINIC BILLING OFFICE
Mailing Address - City:ODANAH
Mailing Address - State:WI
Mailing Address - Zip Code:54861-0250
Mailing Address - Country:US
Mailing Address - Phone:715-685-7858
Mailing Address - Fax:715-685-7857
Practice Address - Street 1:303 ELM STREET
Practice Address - Street 2:COMMUNTIY HEALTH
Practice Address - City:ODANAH
Practice Address - State:WI
Practice Address - Zip Code:54861
Practice Address - Country:US
Practice Address - Phone:715-682-7111
Practice Address - Fax:715-685-7857
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI142336-30163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health