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General NPI Number Information
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NPI Number | 1396250320
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Entity Type | Individual
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Provider Name | NICOLE MANUEL APN
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Gender | Female
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 284 MEMORIAL CT STE B
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6231
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Country | US
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Telephone | 815-477-8900
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Fax | 815-477-7160
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Provider Business Mailing Address
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Address Line | 600 HART RD STE 100
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City | BARRINGTON
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State | IL
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Zip | 60010-2662
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Country | US
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Telephone | 815-477-8900
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Fax | 815-477-7160
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 209.006547
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.006547
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License Number State | IL
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