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Individual

THERESA MANNING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
120 BEACON ST STE 202, HOUSE CALL PROGRAM, SOMERVILLE, MA 02143-4398
(617) 868-6323
Mailing address
120 BEACON ST STE 202, HOUSE CALL PROGRAM, SOMERVILLE, MA 02143-4398
(617) 868-6323

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
192595
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
110074832A
MA
01
NP1088
BCBS MA PROVIDER NUMBER
MA
Enumeration date
04/04/2007
Last updated
02/07/2012
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