Provider Demographics
NPI:1477200814
Name:MANALASTAS, EDEN (RN)
Entity Type:Individual
Prefix:MS
First Name:EDEN
Middle Name:
Last Name:MANALASTAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:EDEN
Other - Middle Name:
Other - Last Name:MANALASTAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:14484 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2638
Mailing Address - Country:US
Mailing Address - Phone:708-364-0580
Mailing Address - Fax:
Practice Address - Street 1:14484 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2638
Practice Address - Country:US
Practice Address - Phone:708-364-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041281717163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse