Provider Demographics
NPI:1578831335
Name:MANUEL, MYALA DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:MYALA
Middle Name:DENISE
Last Name:MANUEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3297 TULLAMORE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2979
Mailing Address - Country:US
Mailing Address - Phone:216-401-5335
Mailing Address - Fax:
Practice Address - Street 1:3297 TULLAMORE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2979
Practice Address - Country:US
Practice Address - Phone:216-401-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH116890164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse