Provider Demographics
NPI:1104425123
Name:MCMANUS-TOMANEK, ERIN (AGNP-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MCMANUS-TOMANEK
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18275 N 59TH AVE STE 138
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1253
Mailing Address - Country:US
Mailing Address - Phone:602-564-0078
Mailing Address - Fax:602-564-1154
Practice Address - Street 1:18275 N 59TH AVE STE 138
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1253
Practice Address - Country:US
Practice Address - Phone:602-564-0078
Practice Address - Fax:602-564-1154
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250700363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD09463069OtherDRIVERS LICENSE