Provider Demographics
NPI:1619220167
Name:DOU, MANELISA UY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:MANELISA
Middle Name:UY
Last Name:DOU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 SAMARITAN CT FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4001
Mailing Address - Country:US
Mailing Address - Phone:408-523-3870
Mailing Address - Fax:
Practice Address - Street 1:2506 SAMARITAN CT FL 3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4001
Practice Address - Country:US
Practice Address - Phone:408-523-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22417363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health