Healthcare Provider Details

I. General information

NPI: 1134015688
Provider Name (Legal Business Name): RONALD MAX MANES SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 08/19/2025
Certification Date: 06/12/2025
Deactivation Date: 06/19/2025
Reactivation Date: 08/19/2025

III. Provider practice location address

4552 E PRINCESS ANNE RD
NORFOLK VA
23502-1614
US

IV. Provider business mailing address

503 BRACKENRIDGE AVE
NORFOLK VA
23505-4325
US

V. Phone/Fax

Practice location:
  • Phone: 757-748-7847
  • Fax:
Mailing address:
  • Phone: 757-748-7847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: