Provider Demographics
NPI:1730079344
Name:MANIVONG, CHAIPHET
Entity type:Individual
Prefix:MRS
First Name:CHAIPHET
Middle Name:
Last Name:MANIVONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-8047
Mailing Address - Country:US
Mailing Address - Phone:308-383-2495
Mailing Address - Fax:
Practice Address - Street 1:416 E OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-8047
Practice Address - Country:US
Practice Address - Phone:308-383-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider