Provider Demographics
NPI:1073646055
Name:MANKO, CHRISTINE L (CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:MANKO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 FAIRMOUNT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8518
Mailing Address - Country:US
Mailing Address - Phone:443-471-0470
Mailing Address - Fax:410-584-1884
Practice Address - Street 1:1838 GREENE TREE RD STE 225A
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:443-471-0470
Practice Address - Fax:410-584-1884
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR065595363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP03582Medicare UPIN
208095ZR0ZMedicare PIN