Provider Demographics
NPI:1073873477
Name:MANNING-SOLERA, CRYSTAL AGNES
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:AGNES
Last Name:MANNING-SOLERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:AGNES
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4118 WESTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-1533
Mailing Address - Country:US
Mailing Address - Phone:410-908-1957
Mailing Address - Fax:
Practice Address - Street 1:4118 WESTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-1533
Practice Address - Country:US
Practice Address - Phone:410-908-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide