MEDICARE: MRS. DYANNA R MANA RN

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	163W00000X	Registered Nurse	509094-1	NY

General Provider Information

NPI Number	:	1811999147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DYANNA R MANA RN

Provider Business Mailing Address
First Line	:	2530 GREGORY ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-3811
Country	:	US
Telephone Number	:	914-962-6006
Fax Number	:	914-962-2111

Provider Business Practice Location Address
First Line	:	2530 GREGORY ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-3811
Country	:	US
Telephone Number	:	914-962-6006
Fax Number	:	914-962-2111

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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