Healthcare Provider Details

I. General information

NPI: 1992271027
Provider Name (Legal Business Name): MICHAEL SCOTT MANN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 WINSTON DR
MARSHALL MI
49068-8526
US

IV. Provider business mailing address

601 JOHN ST
KALAMAZOO MI
49007-5232
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-9867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704269560
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: