Provider Demographics
NPI:1396550539
Name:MANALO, RANCE KENDREICK
Entity type:Individual
Prefix:
First Name:RANCE
Middle Name:KENDREICK
Last Name:MANALO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 N CAMINO MERCARDO
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5759
Mailing Address - Country:US
Mailing Address - Phone:520-836-5538
Mailing Address - Fax:844-722-0049
Practice Address - Street 1:560 N CAMINO MERCADO STE 7
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5759
Practice Address - Country:US
Practice Address - Phone:520-836-5538
Practice Address - Fax:844-722-0049
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ197505163WN0300X
AZ322036363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0300XNursing Service ProvidersRegistered NurseNephrology