Provider Demographics
NPI:1013930924
Name:MANAHAN, ELAINE M (RD CDE NISC)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:M
Last Name:MANAHAN
Suffix:
Gender:F
Credentials:RD CDE NISC
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:M
Other - Last Name:WASSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:7519 E SUTTON
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-778-9155
Mailing Address - Fax:
Practice Address - Street 1:650 E INDIAN SCHOOL
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R363172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered