Provider Demographics
NPI:1508634080
Name:MANN, EARL
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:
Last Name:MANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 S HUALAPAI WAY UNIT 1228
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7280
Mailing Address - Country:US
Mailing Address - Phone:202-744-1234
Mailing Address - Fax:
Practice Address - Street 1:4555 S FORT APACHE RD STE 1081228
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7971
Practice Address - Country:US
Practice Address - Phone:202-744-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNONE171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach