Provider Demographics
NPI:1346061678
Name:MANLEY, ERIN MARIE (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 E 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1828
Mailing Address - Country:US
Mailing Address - Phone:907-727-6191
Mailing Address - Fax:
Practice Address - Street 1:6401 E 112TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-1828
Practice Address - Country:US
Practice Address - Phone:907-727-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK89133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered