Jenny Ann Managbanag, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

6250-33 Issued in WI

Practice address

1969 W. Hart Road
Beloit Memorial Hospital
Beloit, WI 53511-2230

Phone

(608) 364-5011

Fax

(608) 364-5593

NPI assigned

Feb 4, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jenny Ann Salve Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424822400000",
    "number": "1558751198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 E. HUEBBE PARKWAY",
            "address_2": "BELOIT HEALTH SYSTEM",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111842",
            "telephone_number": "608-364-2200",
            "fax_number": "608-363-7395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1969 W. HART ROAD",
            "address_2": "BELOIT MEMORIAL HOSPITAL",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535112230",
            "telephone_number": "608-364-5011",
            "fax_number": "608-364-5593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANAGBANAG",
        "first_name": "JENNY",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-04",
        "last_updated": "2015-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-012264",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "6250-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNY",
            "last_name": "SALVE",
            "middle_name": "ANN",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nadia Lutgebuter, APSW
• Lutheran Social Services of Wisconsin and Upper Michigan, Inc.
• Abigail Luty, LPC-IT
• Clinton Melliza Magno
• John J Maher, MD
• Audrey Elaine Marchillo, SACIT
• Leah Renee Markham, PHARMD
• Peter H. Marks, M.D.
• Scott E. Marquardt, LPC
• Taylore Lynn Martin, MSW, LCSW

• Nurse Practitioner in Beloit, WI
• Providers in Beloit, WI by specialty
• Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.