Provider Demographics
NPI:1689497414
Name:MCMANUS, CAROLYN DENISE WEATHERS (AGCNS, RB, OCN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DENISE WEATHERS
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:AGCNS, RB, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34401 WESTSTAR RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-1228
Mailing Address - Country:US
Mailing Address - Phone:405-412-8509
Mailing Address - Fax:
Practice Address - Street 1:34401 WESTSTAR RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-1228
Practice Address - Country:US
Practice Address - Phone:405-412-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4821364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology