Provider Demographics
NPI:1447573985
Name:HOWARD, MANTA LATRICE (RN)
Entity Type:Individual
Prefix:
First Name:MANTA
Middle Name:LATRICE
Last Name:HOWARD
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 1:5736 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-2203
Mailing Address - Country:US
Mailing Address - Phone:414-628-1012
Mailing Address - Fax:
Practice Address - Street 1:5736 N 68TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-2203
Practice Address - Country:US
Practice Address - Phone:414-628-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164137-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse