Provider Demographics
NPI:1184308033
Name:MANYBEADS, MERILENE
Entity type:Individual
Prefix:
First Name:MERILENE
Middle Name:
Last Name:MANYBEADS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4555
Mailing Address - Street 2:ROUTE 4; 3.5 SW BLUE GAP JUNCTION
Mailing Address - City:BLUE GAP
Mailing Address - State:AZ
Mailing Address - Zip Code:86520-4555
Mailing Address - Country:US
Mailing Address - Phone:928-675-1617
Mailing Address - Fax:928-725-3580
Practice Address - Street 1:ROUTE 4; 3.5 SW BLUE GAP JUNCTION
Practice Address - Street 2:
Practice Address - City:BLUE GAP
Practice Address - State:AZ
Practice Address - Zip Code:86520-4555
Practice Address - Country:US
Practice Address - Phone:928-675-1617
Practice Address - Fax:928-725-3580
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide