Provider Demographics
NPI:1033607411
Name:MANONO, ROSELINE OSEBE
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:OSEBE
Last Name:MANONO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 CREEKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-4639
Mailing Address - Country:US
Mailing Address - Phone:469-684-7506
Mailing Address - Fax:
Practice Address - Street 1:1529 CREEKSTONE CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-4639
Practice Address - Country:US
Practice Address - Phone:469-684-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX942725163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse