Provider Demographics
NPI:1508280595
Name:MANULKIN, STEPHANIE ELIZABETH (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:MANULKIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:ELIZABETH
Other - Last Name:HERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:1004 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2502
Practice Address - Country:US
Practice Address - Phone:415-590-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily