Provider Demographics
NPI:1295394526
Name:MCMANAMAN, ELISE (NP)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:MCMANAMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:M
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 S DESPLAINES ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3005 PEACHTREE RD NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2214
Practice Address - Country:US
Practice Address - Phone:470-765-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019477363LW0102X
DCRN1031565363LW0102X
VA0024177602363LW0102X
GARN319751363LW0102X
NY421651363LW0102X
MDR232320363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2014107550Medicaid