Individual
EDNA M MANALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2516 E DUPONT RD, FORT WAYNE, IN 46825-1608
(260) 471-7197
(260) 471-7408
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3516
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000418A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100326320
—
IN
01
—
P01146780
RAILROAD MEDICARE
IN
Enumeration date
01/02/2006
Last updated
10/13/2020
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