Provider Demographics
NPI:1992924310
Name:MANN, KATHERINE SAWYER (FAMILY NURSE PRACTIT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:SAWYER
Last Name:MANN
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:SAWYER
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:5300 ORTON POINT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4088
Mailing Address - Country:US
Mailing Address - Phone:910-612-8066
Mailing Address - Fax:
Practice Address - Street 1:1410 COMMONWEALTH DR STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0314
Practice Address - Country:US
Practice Address - Phone:910-679-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC086857363L00000X
NC200612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCD183C618Medicare PIN