Provider Demographics
NPI:1164277364
Name:MANNS, ERICA LYNN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:MANNS
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 1:11342 PINE MOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-9543
Mailing Address - Country:US
Mailing Address - Phone:317-828-0750
Mailing Address - Fax:
Practice Address - Street 1:1717 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2733
Practice Address - Country:US
Practice Address - Phone:317-828-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBC202009501744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management