| Doctor Name: | MYRTIS MANIGO |
| NPI Number: | 1457757361 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 412189310 |
| Business Practice Address: | 4500 Fort Jackson Blvd Columbia, SC - 292091119 |
| Business Phone Number: | 8037821008 |
| Business Fax Number: | |
| Mailing Address: | Po Box 90506, COLUMBIA |
| State: | SC |
| Postal Code: | 292901506 |
| Phone Number: | 8037821008 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2014 |
| NPI Last Update Date: | 11/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 374U00000X |
| License Number: | 412189310 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Home Health Aide |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person trained to assist public health nurses, home health nurses, and other health professionals in the bedside care of patients in their homes. |