Healthcare Provider Details

I. General information

NPI: 1073873477
Provider Name (Legal Business Name): MS. CRYSTAL AGNES MANNING-SOLERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTAL AGNES MANNING

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 WESTCHESTER RD
BALTIMORE MD
21216-1533
US

IV. Provider business mailing address

4118 WESTCHESTER RD
BALTIMORE MD
21216-1533
US

V. Phone/Fax

Practice location:
  • Phone: 410-908-1957
  • Fax:
Mailing address:
  • Phone: 410-908-1957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: