Provider Demographics
NPI:1851551899
Name:MANN, ELIZA JANE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ELIZA
Middle Name:JANE
Last Name:MANN
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 1:2975 INDEPENDENCE AVE
Mailing Address - Street 2:APT. LOL335
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4620
Mailing Address - Country:US
Mailing Address - Phone:908-752-1472
Mailing Address - Fax:
Practice Address - Street 1:2975 INDEPENDENCE AVE
Practice Address - Street 2:APT. LOL335
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4620
Practice Address - Country:US
Practice Address - Phone:908-752-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218498-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse