Provider Demographics
NPI:1003196304
Name:MANAMOLELA, DINEO (RN)
Entity Type:Individual
Prefix:
First Name:DINEO
Middle Name:
Last Name:MANAMOLELA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 23RD ST
Mailing Address - Street 2:APT#34
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7058
Mailing Address - Country:US
Mailing Address - Phone:718-671-2100
Mailing Address - Fax:
Practice Address - Street 1:301 E 23RD ST
Practice Address - Street 2:APT#34
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7058
Practice Address - Country:US
Practice Address - Phone:718-671-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY644632163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse