Provider Demographics
NPI:1386990497
Name:MANCZKO, ELIZABETH DANIELLE LOVERDE
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DANIELLE LOVERDE
Last Name:MANCZKO
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 1:163 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2430
Mailing Address - Country:US
Mailing Address - Phone:630-947-4130
Mailing Address - Fax:
Practice Address - Street 1:800 S WELLS ST STE 130
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4553
Practice Address - Country:US
Practice Address - Phone:312-922-2923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program