1467457622 NPI number — CAROLINE G MANSY FNP

Table of content: CAROLINE G MANSY FNP (NPI 1467457622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467457622 NPI number — CAROLINE G MANSY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANSY
Provider First Name:
CAROLINE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467457622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1340 BELMONT AVE UNIT 503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-4590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-978-3000
Provider Business Mailing Address Fax Number:
855-274-7151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1340 BELMONT AVE UNIT 503
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21804-4590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-978-3000
Provider Business Practice Location Address Fax Number:
855-274-7151
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  113099 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 412959800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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