Healthcare Provider Details

I. General information

NPI: 1831778844
Provider Name (Legal Business Name): ELEANOR LATRICE MANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 FOWL RD APT 411
ELYRIA OH
44035-4439
US

IV. Provider business mailing address

1936 FOWL RD APT 411
ELYRIA OH
44035-4439
US

V. Phone/Fax

Practice location:
  • Phone: 269-277-0213
  • Fax:
Mailing address:
  • Phone: 269-277-0213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN712090
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR43693
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101248
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number39685
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: