Individual
JENNIPHER IMMANUEL MANOHAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP, FNP
Contact information
Practice address
2715 COLONIAL DR, COLUMBIA, SC 29203-6818
(803) 898-1555
(803) 898-2194
Mailing address
PO BOX 1631, ROANOKE RAPIDS, NC 27870-7631
(803) 450-8862
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
0024179774
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
28100
SC
Other
Enumeration date
09/04/2023
Last updated
05/30/2024
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