Provider Demographics
NPI:1538793443
Name:ANTHONY-MANSWELL, CORINNE MARCIA (NP)
Entity type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:MARCIA
Last Name:ANTHONY-MANSWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:MARCIA
Other - Last Name:MANSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2000 PILLARGATE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5547
Mailing Address - Country:US
Mailing Address - Phone:678-488-0347
Mailing Address - Fax:
Practice Address - Street 1:8400 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3735
Practice Address - Country:US
Practice Address - Phone:262-884-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA185794363LF0000X
WI100477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100234465Medicaid