Healthcare Provider Details

I. General information

NPI: 1437829017
Provider Name (Legal Business Name): EMILY ANN MANNING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

4785 RICHARD LN
EAGAN MN
55122-2782
US

V. Phone/Fax

Practice location:
  • Phone: 870-373-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11507
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: