Individual
MARY JEANETTE MANNINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
26701 CROWN VALLEY PKWY, MISSION VIEJO, CA 92691-6356
(949) 582-1090
Mailing address
PO BOX 34940, SEATTLE, WA 98124-1940
(503) 372-2740
(503) 372-2754
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
277677
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
773
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RN2776770
—
CA
Enumeration date
05/09/2006
Last updated
07/01/2013
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