Provider Demographics
NPI:1275351900
Name:MANRIQUEZ-HURTADO, ANA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:MANRIQUEZ-HURTADO
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 1:4 PARTNER PL
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-6375
Mailing Address - Country:US
Mailing Address - Phone:309-433-3935
Mailing Address - Fax:
Practice Address - Street 1:4 PARTNER PL
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-6375
Practice Address - Country:US
Practice Address - Phone:309-433-3935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program