1487171666 NPI number — MANOTTE ETIENNE RN, MSN, FNP-C

Table of content: MANOTTE ETIENNE RN, MSN, FNP-C (NPI 1487171666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487171666 NPI number — MANOTTE ETIENNE RN, MSN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ETIENNE
Provider First Name:
MANOTTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERCEDA
Provider Other First Name:
MANOTTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487171666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 HARRISBURG ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BERLIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17316-9505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-259-0222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 HARRISBURG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-259-0222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2017

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:  SP017849 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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