Provider Demographics
NPI:1134208820
Name:MANOR, BETSY LYNNE (MD)
Entity type:Individual
Prefix:MISS
First Name:BETSY
Middle Name:LYNNE
Last Name:MANOR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1121 E NORTH AVE
Mailing Address - Street 2:COLUMBIA-ST. MARY'S FAMILY MEDICINE CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3515
Mailing Address - Country:US
Mailing Address - Phone:414-267-6500
Mailing Address - Fax:414-267-3894
Practice Address - Street 1:535 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1449
Practice Address - Country:US
Practice Address - Phone:715-243-3400
Practice Address - Fax:414-267-3894
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI49651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1134208820Medicaid
WI117873601Medicare PIN