MEDICARE: MARK ANTHONY MANUEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	RN-897509	NV

General Provider Information

NPI Number	:	1093641490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ANTHONY MANUEL

Provider Business Mailing Address
First Line	:	5400 KENNEDY HILL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7450
Country	:	US
Telephone Number	:	808-348-4345
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 KENNEDY HILL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7450
Country	:	US
Telephone Number	:	808-348-4345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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