Provider Demographics
NPI:1215291315
Name:MANS, NICOLE ZEANETTE SPECTOR (MS, LCGC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ZEANETTE SPECTOR
Last Name:MANS
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2279 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1514
Mailing Address - Country:US
Mailing Address - Phone:916-734-5959
Mailing Address - Fax:916-457-4531
Practice Address - Street 1:2279 45TH ST
Practice Address - Street 2:FAMILIAL CANCER PROGRAM
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-4314
Practice Address - Fax:916-457-4531
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000424170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS