Doctor Name: | MISS AUDREY MANIS |
NPI Number: | 1972959187 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MT-BC |
License Number: | 12362 |
Business Practice Address: | 1205 Applegate Ln Clarksville, IN - 471299608 |
Business Phone Number: | 8122838383 |
Business Fax Number: | |
Mailing Address: | 1483 Saint James Ct, LOUISVILLE |
State: | KY |
Postal Code: | 402082145 |
Phone Number: | 9315812129 |
Fax Number: | |
NPI Enumeration Date: | 05/05/2016 |
NPI Last Update Date: | 05/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 12362 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |