Doctor Name: | MANUEL LUIS MANALO |
NPI Number: | 1053527655 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | R.N. |
License Number: | 28096714A |
Business Practice Address: | 1098 S State Road 25 Logansport, IN - 469476723 |
Business Phone Number: | 5747224141 |
Business Fax Number: | |
Mailing Address: | 7119 E Co Rd 150 N, LOGANSPORT |
State: | IN |
Postal Code: | 46947 |
Phone Number: | 5747356808 |
Fax Number: | |
NPI Enumeration Date: | 05/14/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0808X |
License Number: | 28096714A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |