Individual
KATHLEEN MCMANNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDH
Contact information
Practice address
4629 MELTON RD, GARY, IN 46403-2866
(219) 938-2637
Mailing address
1267 W 95TH PL, CROWN POINT, IN 46307-2276
(219) 628-5295
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13007475A
IN
Other
Enumeration date
05/25/2018
Last updated
05/25/2018
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