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General NPI Number Information
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NPI Number | 1124396072
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Entity Type | Individual
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Provider Name | SANDRA R GATES-MANNA NP
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Gender | Female
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 1509 STATE ST
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City | LA PORTE
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State | IN
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Zip | 46350-3115
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Country | US
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Telephone | 219-325-5434
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Fax | 219-325-7655
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Provider Business Mailing Address
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Address Line | PO BOX 1690
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City | LA PORTE
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State | IN
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Zip | 46352-1690
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Country | US
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Telephone | 219-326-2312
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Fax | 219-326-2584
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28125285A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71003896A
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License Number State | IN
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