Individual
LINDA ANN MANNINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN BC MSN CNP
Contact information
Practice address
25195 KELLY RD, SUITE A, ROSEVILLE, MI 48066-4909
(586) 775-4594
(586) 775-4506
Mailing address
25195 KELLY RD, SUITE A, ROSEVILLE, MI 48066-4909
(586) 775-4594
(586) 775-4506
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704148987
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
496016910
—
MI
01
—
500 866 4760
BCBS
MI
01
—
OH-26467022
MEDICARE ID
MI
Enumeration date
08/02/2006
Last updated
02/01/2013
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