Provider Demographics
NPI:1548246614
Name:MCMANUS, LAURIE S (FNP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:S
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-296-8333
Mailing Address - Fax:520-296-8444
Practice Address - Street 1:6274 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5831
Practice Address - Country:US
Practice Address - Phone:520-296-8333
Practice Address - Fax:520-296-8444
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ927155Medicaid
P54941Medicare UPIN
AZ104193Medicare PIN