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General NPI Number Information
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NPI Number | 1164277364
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Entity Type | Individual
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Provider Name | ERICA LYNN MANNS
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Gender | Female
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 1717 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-2733
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Country | US
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Telephone | 317-828-0750
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Fax |
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Provider Business Mailing Address
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Address Line | 11342 PINE MOUNTAIN PL
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-9543
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Country | US
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Telephone | 317-828-0750
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Fax |
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | BC20200950
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License Number State | IN
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