1447438353 NPI number — MRS. ANGELA K MORAN MANZITTO PA

Table of content: MRS. ANGELA K MORAN MANZITTO PA (NPI 1447438353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447438353 NPI number — MRS. ANGELA K MORAN MANZITTO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAN MANZITTO
Provider First Name:
ANGELA
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORAN
Provider Other First Name:
ANGELA
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1447438353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8055 O ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68510-2564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-421-0904
Provider Business Mailing Address Fax Number:
402-421-0946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 S 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-483-6000
Provider Business Practice Location Address Fax Number:
402-483-6106
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  1371 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X , with the licence number: 1371 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com