Provider Demographics
NPI:1336891068
Name:MANIFF, LAURA MARY (RD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARY
Last Name:MANIFF
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10208 CERNY ST STE 301
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-1000
Mailing Address - Country:US
Mailing Address - Phone:919-354-7077
Mailing Address - Fax:
Practice Address - Street 1:1520 SUDAY DRIVE
Practice Address - Street 2:STE 309
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-1000
Practice Address - Country:US
Practice Address - Phone:919-354-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005878133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCL005878OtherLICENSED DIETITIAN/NUTRITIONIST NC
86148003OtherCOMMISSION OF DIETETIC REGISTRATION