Healthcare Provider Details

I. General information

NPI: 1265819775
Provider Name (Legal Business Name): MAGDALENA RUTH MANNES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MAGDALENA RUTH SCHWARTZ

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E. COLISEUM BLVD WALB STUDENT UNION ROOM 234
FORT WAYNE IN
46805
US

IV. Provider business mailing address

4140 BERGAMOT DR
FORT WAYNE IN
46845-8005
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-0111
  • Fax:
Mailing address:
  • Phone: 260-246-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005492A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: