Provider Demographics
NPI:1528631603
Name:MANSO, ELIZABETH MAE (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MAE
Last Name:MANSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MAE
Other - Last Name:QUINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:36 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1651
Mailing Address - Country:US
Mailing Address - Phone:508-397-6796
Mailing Address - Fax:
Practice Address - Street 1:36 EVERETT ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1651
Practice Address - Country:US
Practice Address - Phone:508-397-6796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2321536163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine