Provider Demographics
NPI:1558583377
Name:MANNON, ROSLYN BERNSTEIN (MD)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:BERNSTEIN
Last Name:MANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:420-559-9227
Mailing Address - Fax:
Practice Address - Street 1:EMILE @ 42ND STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-2060
Practice Address - Country:US
Practice Address - Phone:402-559-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE32303207RN0300X
AL28905207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051591229OtherBCBS
AL051591231OtherBCBS
AL102564Medicaid
AL102565Medicaid
AL102564Medicaid