Provider Demographics
NPI:1174921365
Name:MANZLAK, LINDSAY NICOLE (MSN, WHNP-BC)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:NICOLE
Last Name:MANZLAK
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 TECH CENTER PKWY STE 200-106
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3075
Mailing Address - Country:US
Mailing Address - Phone:757-960-7454
Mailing Address - Fax:757-866-5577
Practice Address - Street 1:700 TECH CENTER PKWY STE 200-106
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3075
Practice Address - Country:US
Practice Address - Phone:757-960-7454
Practice Address - Fax:757-866-5577
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-21
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171886363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10716Medicare PIN