Provider Demographics
NPI:1205521200
Name:MANNA HEALTH CARE PLLC
Entity type:Organization
Organization Name:MANNA HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:NARUNA
Authorized Official - Last Name:BADEJO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:682-252-4698
Mailing Address - Street 1:6011 PIETRO DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8744
Mailing Address - Country:US
Mailing Address - Phone:817-323-4471
Mailing Address - Fax:
Practice Address - Street 1:1901 SOUTHEAST PKWY STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-3601
Practice Address - Country:US
Practice Address - Phone:682-252-4698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty