Healthcare Provider Details

I. General information

NPI: 1184534463
Provider Name (Legal Business Name): CASSIE MANZI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10640 165TH ST
ORLAND PARK IL
60467-8734
US

IV. Provider business mailing address

10640 165TH ST
ORLAND PARK IL
60467-8734
US

V. Phone/Fax

Practice location:
  • Phone: 708-364-0261
  • Fax:
Mailing address:
  • Phone: 708-364-0261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: