Provider Demographics
NPI:1770756504
Name:MANFRESCA, GINA RECHELLE (LPN)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:RECHELLE
Last Name:MANFRESCA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 HILDENBORO DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1867
Mailing Address - Country:US
Mailing Address - Phone:614-374-6635
Mailing Address - Fax:
Practice Address - Street 1:6080 HILDENBORO DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1867
Practice Address - Country:US
Practice Address - Phone:614-374-6635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2008-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN078874164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse