Provider Demographics
NPI:1063138790
Name:MANTKOWSKI, MARYANN
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:MANTKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6446 BONROI DR
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-3150
Mailing Address - Country:US
Mailing Address - Phone:216-557-3868
Mailing Address - Fax:216-232-1131
Practice Address - Street 1:6446 BONROI DR
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-3150
Practice Address - Country:US
Practice Address - Phone:216-557-3868
Practice Address - Fax:216-232-1131
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide