Provider Demographics
NPI:1740346188
Name:MANSFIELD, VERA PAULINE (CST, SA-C, CSFA)
Entity type:Individual
Prefix:MRS
First Name:VERA
Middle Name:PAULINE
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:CST, SA-C, CSFA
Other - Prefix:
Other - First Name:VERA
Other - Middle Name:PAULINE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2411 E RIVERSIDE DR APT H303
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7552
Mailing Address - Country:US
Mailing Address - Phone:208-724-2223
Mailing Address - Fax:
Practice Address - Street 1:2411 E RIVERSIDE DR APT H303
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7552
Practice Address - Country:US
Practice Address - Phone:208-724-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID109984208600000X, 246ZC0007X
246ZS0410X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
06-158OtherAM BOARD OF SURG ASSIST
ID109984OtherNBSTSA