Provider Demographics
NPI:1831216928
Name:MANASSE, ARLYNN H (MPH APN CPNP)
Entity type:Individual
Prefix:MRS
First Name:ARLYNN
Middle Name:H
Last Name:MANASSE
Suffix:
Gender:F
Credentials:MPH APN CPNP
Other - Prefix:
Other - First Name:A
Other - Middle Name:
Other - Last Name:MANASSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:107 56TH COURT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1530
Mailing Address - Country:US
Mailing Address - Phone:630-960-2142
Mailing Address - Fax:
Practice Address - Street 1:4909 W DIVISION STREET
Practice Address - Street 2:3RD FLOOR CIRCLE FAMILY CARE HEALTH CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651
Practice Address - Country:US
Practice Address - Phone:773-921-8100
Practice Address - Fax:773-921-4428
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000394363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM0759300OtherDEA REGISTRATION