Individual provider Active NPI

Roxanne Manko

  • Community Health Worker
  • Shelby Township, MI
National Provider Identifier
1649648122
Registry record updated Sep 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Practice address
14488 Tyngsboro CT
Shelby Township, MI 48315-3794
Phone
(586) 580-3106
NPI assigned
Sep 14, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 14, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X MI Primary

Addresses

Primary practice location

14488 Tyngsboro CT
Shelby Township, MI 48315-3794

Mailing address

14488 Tyngsboro CT
Shelby Township, MI 48315-3794
Phone (586) 580-3106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442188800000",
    "number": "1649648122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14488 TYNGSBORO CT",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483153794",
            "telephone_number": "586-580-3106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14488 TYNGSBORO CT",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483153794",
            "telephone_number": "586-580-3106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANKO",
        "first_name": "ROXANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-14",
        "last_updated": "2015-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2015; 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.