Provider Demographics
NPI:1265819775
Name:MANNES, MAGDALENA RUTH (NP)
Entity type:Individual
Prefix:MS
First Name:MAGDALENA
Middle Name:RUTH
Last Name:MANNES
Suffix:
Gender:
Credentials:NP
Other - Prefix:MRS
Other - First Name:MAGDALENA
Other - Middle Name:RUTH
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2101 E. COLISEUM BLVD WALB ROOM 236 FORT WAYNE IN 46805
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805
Mailing Address - Country:US
Mailing Address - Phone:260-481-5749
Mailing Address - Fax:765-496-6656
Practice Address - Street 1:2101 E. COLISEUM BLVD
Practice Address - Street 2:WALB STUDENT UNION ROOM 234
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805
Practice Address - Country:US
Practice Address - Phone:765-494-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28141994A163W00000X
IN71005492A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71005492AOtherINDIANA NP PRESCRIPTIVE AUTHORITY
IN201306250Medicaid