Individual
ASHIMA MANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
128 WILLOW ST, WALTHAM, MA 02453-8329
(617) 840-1845
Mailing address
128 WILLOW ST, WALTHAM, MA 02453-8329
(617) 840-1845
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
259466
MA
363LG0600X
Gerontology Nurse Practitioner
259466
MA
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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