Basic Information
| Provider Information | |||||||||
| NPI: | 1639469760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANZER | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAMERAND | ||||||||
| OtherFirstName: | ANDREA | ||||||||
| OtherMiddleName: | K | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 250 | ||||||||
| Address2: | BAD RIVER CLINIC BILLING OFFICE | ||||||||
| City: | ODANAH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548610250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156857858 | ||||||||
| FaxNumber: | 7156857857 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 ELM STREET | ||||||||
| Address2: | COMMUNTIY HEALTH | ||||||||
| City: | ODANAH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156827111 | ||||||||
| FaxNumber: | 7156857857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2011 | ||||||||
| LastUpdateDate: | 05/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 142336-30 | WI | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.