Individual
MRS. JENNIFER TARA MANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD LDN
Contact information
Practice address
16501 NORTHCROSS DRIVE, SUITE D, HUNTERSVILLE, NC 28078
(704) 895-9865
(704) 895-9870
Mailing address
19809 B NORTH COVE RD, STE 108, CORNELIUS, NC 28031
(704) 651-2666
(704) 895-3673
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L000635
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139J5
BCBS
NC
01
—
9220313
CIGNA
NC
Enumeration date
12/08/2006
Last updated
07/08/2007
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