Provider Demographics
NPI:1720750730
Name:MANIBUSAN, NICOLE YVETTE (RN)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:YVETTE
Last Name:MANIBUSAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:MANIBUSAN
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3020 17TH AVENUE CT NW UNIT B
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8822
Mailing Address - Country:US
Mailing Address - Phone:253-590-7577
Mailing Address - Fax:
Practice Address - Street 1:30 HUNTER LN
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2400
Practice Address - Country:US
Practice Address - Phone:253-590-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60230035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse