Provider Demographics
NPI:1912141375
Name:MANIGAT, ROSE-LAURE (RN)
Entity type:Individual
Prefix:MRS
First Name:ROSE-LAURE
Middle Name:
Last Name:MANIGAT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ROSE-LAURE
Other - Middle Name:
Other - Last Name:MANIGAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:375 PETTICOAT LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12721-3047
Mailing Address - Country:US
Mailing Address - Phone:845-733-4084
Mailing Address - Fax:
Practice Address - Street 1:375 PETTICOAT LN
Practice Address - Street 2:
Practice Address - City:BLOOMINGBURG
Practice Address - State:NY
Practice Address - Zip Code:12721-3047
Practice Address - Country:US
Practice Address - Phone:845-733-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY591490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse