Individual
MS. MAGDALENA RUTH MANNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2101 E. COLISEUM BLVD, WALB STUDENT UNION ROOM 234, FORT WAYNE, IN 46805
(765) 494-0111
Mailing address
2101 E. COLISEUM BLVD WALB ROOM 236 FORT WAYNE IN 46805, FORT WAYNE, IN 46805
(260) 481-5749
(765) 496-6656
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28141994A
IN
363L00000X
Nurse Practitioner
Primary
71005492A
IN
363LF0000X
Family Nurse Practitioner
71005492A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201306250
—
IN
01
—
71005492A
INDIANA NP PRESCRIPTIVE AUTHORITY
IN
Enumeration date
05/05/2015
Last updated
04/21/2025
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