Provider Demographics
NPI:1194205096
Name:MANU, LORRAINE E (LPN)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:E
Last Name:MANU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 MACOMBS RD APT 4J
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-2128
Mailing Address - Country:US
Mailing Address - Phone:646-938-5681
Mailing Address - Fax:718-901-8130
Practice Address - Street 1:1491 MACOMBS ROAD
Practice Address - Street 2:APT 4J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452
Practice Address - Country:US
Practice Address - Phone:646-938-5681
Practice Address - Fax:718-901-1082
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY305470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse