Provider Demographics
NPI:1316488836
Name:MCMANUS, MARY JANE (PMHNP, FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-5502
Mailing Address - Country:US
Mailing Address - Phone:843-945-1452
Mailing Address - Fax:843-945-1489
Practice Address - Street 1:2111 HIGHWAY 17 S STE 3
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-4391
Practice Address - Country:US
Practice Address - Phone:843-491-3344
Practice Address - Fax:843-491-3399
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21348363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily