Provider Demographics
NPI:1801576566
Name:MANANDHAR, MARY BETH
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:MANANDHAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COY TRL
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-9472
Mailing Address - Country:US
Mailing Address - Phone:501-499-3796
Mailing Address - Fax:
Practice Address - Street 1:602 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2601
Practice Address - Country:US
Practice Address - Phone:501-743-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program