Individual
MRS. NICOLE KELLEY MANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
102 SHORE DR, SUITE 403, WORCESTER, MA 01605-3154
(508) 856-0458
Mailing address
6 BRENDAN DR, GRAFTON, MA 01519-2000
(508) 887-8780
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
236464
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110096015A
—
MA
Enumeration date
12/06/2012
Last updated
11/12/2014
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