Provider Demographics
NPI:1801943964
Name:MANCUSO, ARLENE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:MARIE
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ARLENE
Other - Middle Name:MARIE
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:140 S GILBERT ROAD
Mailing Address - Street 2:GILBERT PUBLIC SCHOOLS MEDICAID SBCP
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296
Mailing Address - Country:US
Mailing Address - Phone:480-545-3826
Mailing Address - Fax:480-813-5974
Practice Address - Street 1:7125 E MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-641-6413
Practice Address - Fax:480-854-8871
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 056438163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse