Basic Information
| Provider Information | |||||||||
| NPI: | 1265943435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANFREDO | ||||||||
| FirstName: | KORI | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | CRNP, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3504 IVY DR | ||||||||
| Address2: | |||||||||
| City: | MURRYSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156681607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126139762 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 951 MARINERS ISLAND BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944041560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722174557 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2017 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP017974 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.