Healthcare Provider Details

I. General information

NPI: 1619472404
Provider Name (Legal Business Name): HEIDI LYNN MANNING ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2537 E MARKET ST
WARREN OH
44483-6257
US

IV. Provider business mailing address

112 EASTWIND DR NE
WARREN OH
44484-6017
US

V. Phone/Fax

Practice location:
  • Phone: 330-460-5514
  • Fax:
Mailing address:
  • Phone: 330-980-1392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0027208
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: