Provider Demographics
NPI:1093565145
Name:JUSSAB, MANUKU ANN
Entity Type:Individual
Prefix:
First Name:MANUKU
Middle Name:ANN
Last Name:JUSSAB
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 1:3737 TIMBERGLEN RD APT 2511
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-3656
Mailing Address - Country:US
Mailing Address - Phone:817-210-9881
Mailing Address - Fax:
Practice Address - Street 1:3737 TIMBERGLEN RD APT 2511
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-3656
Practice Address - Country:US
Practice Address - Phone:817-210-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No385H00000XRespite Care FacilityRespite Care