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General NPI Number Information
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NPI Number | 1184308033
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Entity Type | Individual
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Provider Name | MERILENE MANYBEADS
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Gender | Female
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | ROUTE 4; 3.5 SW BLUE GAP JUNCTION
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City | BLUE GAP
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State | AZ
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Zip | 86520-4555
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Country | US
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Telephone | 928-675-1617
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Fax | 928-725-3580
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Provider Business Mailing Address
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Address Line | PO BOX 4555 ROUTE 4; 3.5 SW BLUE GAP JUNCTION
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City | BLUE GAP
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State | AZ
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Zip | 86520-4555
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Country | US
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Telephone | 928-675-1617
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Fax | 928-725-3580
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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