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General NPI Number Information
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NPI Number | 1649225103
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Entity Type | Individual
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Provider Name | NICOLE MANLIN ANP
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Gender | Female
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 14855 N OUTER 40
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City | CHESTERFIELD
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State | MO
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Zip | 63017-2026
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Country | US
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Telephone | 636-532-0150
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Fax |
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Provider Business Mailing Address
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Address Line | 14805 N OUTER 40 RD SUITE 320
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City | CHESTERFIELD
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State | MO
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Zip | 63017-6060
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Country | US
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Telephone | 888-811-4677
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 137025
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License Number State | MO
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