Provider Demographics
NPI:1528341351
Name:MANOR, SALLY (RN)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:MANOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13695 STATE HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-3120
Mailing Address - Country:US
Mailing Address - Phone:315-764-3700
Mailing Address - Fax:315-764-3723
Practice Address - Street 1:84 NIGHTENGALE AVE
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-2538
Practice Address - Country:US
Practice Address - Phone:315-764-3720
Practice Address - Fax:315-764-3723
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY293058-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool