Provider Demographics
NPI:1346244258
Name:MCMANUS, MILDRED SUE (APRN C-FNP)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:SUE
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:APRN C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 N ODELL ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-4273
Practice Address - Fax:317-988-2171
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP 04246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28172656AOtherRN LICENSE
LAAP04246OtherLA SBON APRN LIC #
LA020489OtherLA STATE BD NRS ID #
LA1178209Medicaid
IN71002372BOtherCSR
IN71002372AOtherNP REGISTRATION
INMM2113962OtherDEA
INMM2113962OtherDEA
LAAP04246OtherLA SBON APRN LIC #