MEDICARE: NICOLE MANLIN ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	137025	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649225103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MANLIN ANP

Provider Business Mailing Address
First Line	:	14805 N OUTER 40 RD
Second Line	:	SUITE 320
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-6060
Country	:	US
Telephone Number	:	888-811-4677
Fax Number	:

Provider Business Practice Location Address
First Line	:	14855 N OUTER 40
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2026
Country	:	US
Telephone Number	:	636-532-0150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/17/2017

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Directions to “ NICOLE MANLIN ANP” Practice Location

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