Provider Demographics
NPI:1407411325
Name:MANALO, ROWENA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROWENA
Middle Name:M
Last Name:MANALO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 RAMBLING RANGE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4744
Mailing Address - Country:US
Mailing Address - Phone:516-359-5993
Mailing Address - Fax:
Practice Address - Street 1:4109 RAMBLING RANGE DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4744
Practice Address - Country:US
Practice Address - Phone:516-359-5993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX961719163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse