Provider Demographics
NPI:1568643393
Name:MANEY, ANN CAROL
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:CAROL
Last Name:MANEY
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 1:2470 SHELLY CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4021
Mailing Address - Country:US
Mailing Address - Phone:262-789-1056
Mailing Address - Fax:262-789-0234
Practice Address - Street 1:2470 SHELLY CT
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4021
Practice Address - Country:US
Practice Address - Phone:262-789-1056
Practice Address - Fax:262-789-0234
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73390-030163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35044700Medicaid