Individual
MARISSA C MANIBOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
127 BETH CIR, PLYMOUTH, WI 53073-2649
(920) 892-7044
Mailing address
603 E PINE ST APT 8, NEW LONDON, WI 54961-1963
(920) 475-6804
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
313088-31
WI
Other
Enumeration date
05/15/2017
Last updated
05/15/2017
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