Provider Demographics
NPI:1548886682
Name:MANOLACHE, MADALINA
Entity type:Individual
Prefix:
First Name:MADALINA
Middle Name:
Last Name:MANOLACHE
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 1:872 HURON ST
Mailing Address - Street 2:
Mailing Address - City:LASALLE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9J3E7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:872 HURON ST
Practice Address - Street 2:
Practice Address - City:LASALLE
Practice Address - State:ONTARIO
Practice Address - Zip Code:N9J3E7
Practice Address - Country:CA
Practice Address - Phone:226-347-1396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470439184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty