Provider Demographics
NPI:1689484412
Name:MANABAT, ELLAINE (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:ELLAINE
Middle Name:
Last Name:MANABAT
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 AZALEA RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4540
Mailing Address - Country:US
Mailing Address - Phone:919-909-3780
Mailing Address - Fax:
Practice Address - Street 1:3212 AZALEA RIDGE CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4540
Practice Address - Country:US
Practice Address - Phone:919-909-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV811167363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health