Provider Demographics
NPI:1962884833
Name:MANESS, DANIELLE R (WHNP, CNM)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:MANESS
Suffix:
Gender:F
Credentials:WHNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GREAT TEAYS BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9815
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-201-5019
Practice Address - Street 1:97 GREAT TEAYS BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9815
Practice Address - Country:US
Practice Address - Phone:304-757-6999
Practice Address - Fax:304-201-5019
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN80656-MIDWIFE367A00000X
WV80656163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810029556Medicaid
WV1962884833Medicaid
WVQ50801DMedicare PIN
WVQ50801EMedicare PIN
WVQ50801BMedicare PIN
WVQ50801CMedicare PIN