Poonam Manek, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

272871 Issued in AZ

Practice address

19555 N 59TH Ave
Glendale, AZ 85308-6813

Phone

(630) 631-1277

NPI assigned

Nov 12, 2024

Last updated

Nov 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1457175887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19555 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19555 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086813",
            "telephone_number": "630-631-1277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANEK",
        "first_name": "POONAM",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-12",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "272871",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "272871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard A Manch, M.D.
• Amanda Mancilla
• Mancuso Chiro Center LLC (ProFormance Health of Glendale)
• David A Mancuso, D.C.
• Mandeep K Rai PLC
• Timothy Mangin
• Ruth Roberta Mangino, N.P.
• Kayla Mangold
• Annalyce Manka, PT, DPT
• Sherri Mankofsky, RD

• Gerontology Nurse Practitioner in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Gerontology Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.