Provider Demographics
NPI:1730857210
Name:MANUS, ERIN E (RN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:MANUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:E
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:375 GOLDEN POPPY ST
Mailing Address - Street 2:
Mailing Address - City:BOSQUE FARMS
Mailing Address - State:NM
Mailing Address - Zip Code:87068-9552
Mailing Address - Country:US
Mailing Address - Phone:505-450-5048
Mailing Address - Fax:
Practice Address - Street 1:119 LUNA AVE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-865-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR59811163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool