Individual
DR. LUISA T MANESTAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1645 S MAIN ST, SUITE 101, CROSSVILLE, TN 38555-2908
(931) 484-7531
(931) 456-9515
Mailing address
1645 S MAIN ST, SUITE 101, CROSSVILLE, TN 38555-2908
(931) 484-7531
(931) 456-9515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
48768
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4330620
BLUE CROSS BLUE SHIELD
TN
01
—
455420558
TRICARE
TN
01
—
48768
TN STATE MEDICAL LICENSE
TN
Enumeration date
02/22/2007
Last updated
09/19/2012
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