Provider Demographics
NPI:1710643556
Name:MANUEL, ANGELA ELAINE (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ELAINE
Last Name:MANUEL
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 BANYAN RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3109
Mailing Address - Country:US
Mailing Address - Phone:910-978-8122
Mailing Address - Fax:
Practice Address - Street 1:5113 BANYAN RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3109
Practice Address - Country:US
Practice Address - Phone:910-978-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist