Provider Demographics
NPI:1558123810
Name:MANON, ANA LUVIA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LUVIA
Last Name:MANON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 PEARSON DR N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-3174
Mailing Address - Country:US
Mailing Address - Phone:651-239-5300
Mailing Address - Fax:
Practice Address - Street 1:1374 PEARSON DR N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-3174
Practice Address - Country:US
Practice Address - Phone:651-239-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist