Provider Demographics
NPI:1639261753
Name:MANUEL, PAULA (MSN CNM)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:MANUEL
Suffix:
Gender:F
Credentials:MSN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 EAST 72ND PLACE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649
Mailing Address - Country:US
Mailing Address - Phone:708-921-4048
Mailing Address - Fax:
Practice Address - Street 1:PROVIDENT HOSPITAL OF COOK COUNTY
Practice Address - Street 2:500 EAST 51ST STREET
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2400
Practice Address - Country:US
Practice Address - Phone:312-572-2000
Practice Address - Fax:312-572-1294
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife