Provider Demographics
NPI:1477704674
Name:MANNY, COLEEN CAROL (LPN)
Entity Type:Individual
Prefix:MRS
First Name:COLEEN
Middle Name:CAROL
Last Name:MANNY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10035 W PANTHER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45318-9723
Mailing Address - Country:US
Mailing Address - Phone:937-473-5160
Mailing Address - Fax:937-473-5732
Practice Address - Street 1:10035 W PANTHER CREEK RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:OH
Practice Address - Zip Code:45318-9723
Practice Address - Country:US
Practice Address - Phone:937-473-5160
Practice Address - Fax:937-473-5732
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 021694164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse