| Doctor Name: | BLANCHE BELLE MANNERS |
| NPI Number: | 1437382728 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CCMA |
| License Number: | 12225011 |
| Business Practice Address: | 18945 Fm 2252 Ste 115 Garden Ridge, TX - 782662797 |
| Business Phone Number: | 2106510029 |
| Business Fax Number: | |
| Mailing Address: | 13560 County Route 68, RODMAN |
| State: | NY |
| Postal Code: | 136822159 |
| Phone Number: | 3152324059 |
| Fax Number: | |
| NPI Enumeration Date: | 09/02/2009 |
| NPI Last Update Date: | 09/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1102X |
| License Number: | 12225011 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Military Outpatient Operational (Transportable) Component |
| Taxonomy Definition: | |