Individual
BLAYNE MANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 COMMUNITY DR, #110, GREAT NECK, NY 11021-5503
(516) 918-4388
Mailing address
225 COMMUNITY DR, #110, GREAT NECK, NY 11021-5503
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
307828
NY
Other
Enumeration date
08/05/2016
Last updated
08/05/2016
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