Provider Demographics
NPI:1770946337
Name:MANNING, REGINALD (RN)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:MANNING
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 BRAHMAN MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3386
Mailing Address - Country:US
Mailing Address - Phone:336-327-6064
Mailing Address - Fax:
Practice Address - Street 1:2627 BRAHMAN MEADOWS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3386
Practice Address - Country:US
Practice Address - Phone:336-327-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC258266163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical