Provider Demographics
NPI:1528429362
Name:MANENTE, MARIESA
Entity type:Individual
Prefix:MS
First Name:MARIESA
Middle Name:
Last Name:MANENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WINDSOR CHASE TRL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8401
Mailing Address - Country:US
Mailing Address - Phone:770-815-2214
Mailing Address - Fax:
Practice Address - Street 1:240 WINDSOR CHASE TRL
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8401
Practice Address - Country:US
Practice Address - Phone:770-815-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program