Basic Information
| Provider Information | |||||||||
| NPI: | 1740641315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANU | ||||||||
| FirstName: | CHRISTIANA | ||||||||
| MiddleName: | ADIYIAH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 WHITE HORSE AVE | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086101408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062586666 | ||||||||
| FaxNumber: | 6095850309 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 WHITE HORSE AVE SUIT 202 | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095816666 | ||||||||
| FaxNumber: | 6095850309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2016 | ||||||||
| LastUpdateDate: | 03/10/2016 | ||||||||
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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 | 363LF0000X | 26NJ00611100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | F09151418 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.