Provider Demographics
NPI:1003175787
Name:MANNI, MARK ANTONY (NCMA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTONY
Last Name:MANNI
Suffix:
Gender:M
Credentials:NCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 N LANE ST
Mailing Address - Street 2:APARTMENT 8
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1718
Mailing Address - Country:US
Mailing Address - Phone:907-602-1014
Mailing Address - Fax:
Practice Address - Street 1:1104 EAST 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2759
Practice Address - Country:US
Practice Address - Phone:907-602-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator