Provider Demographics
NPI:1447314166
Name:SANIXAY, MANOLA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MANOLA
Middle Name:
Last Name:SANIXAY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MANOLA
Other - Middle Name:
Other - Last Name:KEOPRADIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:4379 RIDGEWOOD CENTER DR STE 102
Practice Address - Street 2:GREATER PRINCE WILLIAM COMMUNITY HEALTH CENTER
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8323
Practice Address - Country:US
Practice Address - Phone:703-680-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164630363L00000X
VA0001113951363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
012917K92Medicare ID - Type Unspecified
Q04158Medicare UPIN