Provider Demographics
NPI:1982425237
Name:MANESS, LAURA (RN, FNP STUDENT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MANESS
Suffix:
Gender:F
Credentials:RN, FNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 COUNTY ROAD 32
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:36722-1103
Mailing Address - Country:US
Mailing Address - Phone:334-431-1916
Mailing Address - Fax:
Practice Address - Street 1:1425 MOSLEY DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3334
Practice Address - Country:US
Practice Address - Phone:334-636-5614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-080624163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse