Provider Demographics
NPI:1366400541
Name:MANWARE, MICHELLE (PA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MANWARE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:100 ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7219
Mailing Address - Country:US
Mailing Address - Phone:503-830-6116
Mailing Address - Fax:508-747-6308
Practice Address - Street 1:118 LONG POND RD
Practice Address - Street 2:JORDAN HOSPITAL OB-GYN
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2662
Practice Address - Country:US
Practice Address - Phone:508-830-3160
Practice Address - Fax:781-340-3782
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1383OtherLICENCE