| Mana Health & Wellness Inc | |
|
4550 N Black Canyon Hwy Phoenix AZ 85017-3714 | |
| (808) 306-3054 | |
| Not Available |
| Full Name | Mana Health & Wellness Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4550 N Black Canyon Hwy, Phoenix, Arizona |
| Authorized Official Name and Position | Sharon Fountain (PRESIDENT) |
| Authorized Official Contact | 8083063054 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mana Health & Wellness Inc 4550 N Black Canyon Hwy Phoenix AZ 85017-3714 Ph: (808) 306-3054 | Mana Health & Wellness Inc 4550 N Black Canyon Hwy Phoenix AZ 85017-3714 Ph: (808) 306-3054 |
| NPI Number | 1043903875 |
|---|---|
| Provider Enumeration Date | 05/29/2023 |
| Last Update Date | 05/13/2025 |
| Certification Date | 05/13/2025 |
| Medicare PECOS PAC ID | 4284089137 |
|---|---|
| Medicare Enrollment ID | O20231012000789 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043903875 | NPI | - | NPPES |
| Provider Name | Luana Louise Rutherford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194287391 PECOS PAC ID: 4082048038 Enrollment ID: I20191227000395 |
| Provider Name | Ian Pedregosa Dy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780288852 PECOS PAC ID: 6901212653 Enrollment ID: I20221004000767 |
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