Provider Demographics
NPI:1710228523
Name:MANHEIMER, LUCITA (RN)
Entity Type:Individual
Prefix:MS
First Name:LUCITA
Middle Name:
Last Name:MANHEIMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HIGHWAY 98 & NAVAJO RTE. 16
Mailing Address - Street 2:
Mailing Address - City:TONALEA
Mailing Address - State:AZ
Mailing Address - Zip Code:86044
Mailing Address - Country:US
Mailing Address - Phone:928-614-8079
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 98 & NAVAJO ROUTE 16
Practice Address - Street 2:
Practice Address - City:SHONTO
Practice Address - State:AZ
Practice Address - Zip Code:86054
Practice Address - Country:US
Practice Address - Phone:928-614-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN126233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse