1083984660 NPI number — MS. KRISTA ALYSSE MANZI BS, SST

Table of content: MS. KRISTA ALYSSE MANZI BS, SST (NPI 1083984660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083984660 NPI number — MS. KRISTA ALYSSE MANZI BS, SST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANZI
Provider First Name:
KRISTA
Provider Middle Name:
ALYSSE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BS, SST
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:
1083984660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 CORE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLANDS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28574-8136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-921-7471
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2708 NE 14TH ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33062-3565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-880-9270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2012

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: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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