Provider Demographics
NPI:1811177819
Name:MANNS, ANITA RAE (NP-C, DNP, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:RAE
Last Name:MANNS
Suffix:
Gender:F
Credentials:NP-C, DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33228 W 12 MILE RD STE 154
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3309
Mailing Address - Country:US
Mailing Address - Phone:313-356-6543
Mailing Address - Fax:
Practice Address - Street 1:33228 W 12 MILE RD
Practice Address - Street 2:STE 154
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3309
Practice Address - Country:US
Practice Address - Phone:734-228-7834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704225569363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health