| Doctor Name: | MANDA C NULL |
| NPI Number: | 1477816874 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DO |
| License Number: | PG158044 |
| Business Practice Address: | 1500 Highlands Dr Lititz, PA - 175437694 |
| Business Phone Number: | 7176255000 |
| Business Fax Number: | |
| Mailing Address: | 11 Sandstone Ct, LITITZ |
| State: | PA |
| Postal Code: | 175437672 |
| Phone Number: | 3125209622 |
| Fax Number: | |
| NPI Enumeration Date: | 06/20/2012 |
| NPI Last Update Date: | 01/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | PG158044 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |