Provider Demographics
NPI:1437925062
Name:MANIGO-BROWN, TANESHA LYNN
Entity type:Individual
Prefix:
First Name:TANESHA
Middle Name:LYNN
Last Name:MANIGO-BROWN
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 1:1050 S 173RD AVE APT 193
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-6425
Mailing Address - Country:US
Mailing Address - Phone:980-406-7756
Mailing Address - Fax:
Practice Address - Street 1:1050 S 173RD AVE APT 193
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-6425
Practice Address - Country:US
Practice Address - Phone:980-406-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician