Provider Demographics
NPI:1639916745
Name:MANTE, MADELINE (RN)
Entity type:Individual
Prefix:MISS
First Name:MADELINE
Middle Name:
Last Name:MANTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39199 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1501
Mailing Address - Country:US
Mailing Address - Phone:510-791-4000
Mailing Address - Fax:510-791-4036
Practice Address - Street 1:39199 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1501
Practice Address - Country:US
Practice Address - Phone:510-791-4000
Practice Address - Fax:510-791-4036
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95360185163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse