Provider Demographics
NPI:1104418045
Name:MANNING, ELONZO JR (COORDINATOR)
Entity type:Individual
Prefix:MR
First Name:ELONZO
Middle Name:
Last Name:MANNING
Suffix:JR
Gender:M
Credentials:COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3210
Mailing Address - Country:US
Mailing Address - Phone:414-731-2140
Mailing Address - Fax:
Practice Address - Street 1:3128 N 50TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-3210
Practice Address - Country:US
Practice Address - Phone:414-817-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator