Individual
MARYGRACE MANZANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
844 KEMPSVILLE RD STE 212, NORFOLK, VA 23502-3927
(757) 261-5977
(757) 275-9913
Mailing address
844 KEMPSVILLE RD STE 212, NORFOLK, VA 23502-3927
(757) 261-5977
(757) 275-9913
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024176270
VA
363LA2100X
Acute Care Nurse Practitioner
Primary
0024176270
VA
363LA2200X
Adult Health Nurse Practitioner
0024176270
VA
363LC0200X
Critical Care Medicine Nurse Practitioner
0024176270
VA
Other
Enumeration date
06/28/2018
Last updated
01/07/2022
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