Provider Demographics
NPI:1407587199
Name:MENGE, MARYANNE
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:MENGE
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 1:6359 WHITBY RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2129
Mailing Address - Country:US
Mailing Address - Phone:612-438-5945
Mailing Address - Fax:
Practice Address - Street 1:6359 WHITBY RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2129
Practice Address - Country:US
Practice Address - Phone:612-438-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach