Provider Demographics
NPI:1831778844
Name:MANNING, ELEANOR LATRICE
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:LATRICE
Last Name:MANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 FOWL RD APT 411
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-4439
Mailing Address - Country:US
Mailing Address - Phone:269-277-0213
Mailing Address - Fax:
Practice Address - Street 1:1936 FOWL RD APT 411
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-4439
Practice Address - Country:US
Practice Address - Phone:269-277-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN712090163W00000X
NDR43693163W00000X
WV101248163W00000X
OH39685163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH096344159OtherUNITED HEALTHCARE