Provider Demographics
NPI:1669814364
Name:MANALANG, ANNE ROWENA (FNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ROWENA
Last Name:MANALANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 ESSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-4912
Mailing Address - Country:US
Mailing Address - Phone:630-897-1895
Mailing Address - Fax:630-897-2043
Practice Address - Street 1:2116 W GALENA BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-3533
Practice Address - Country:US
Practice Address - Phone:630-897-1895
Practice Address - Fax:630-897-2043
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8252002Medicare UPIN