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Individual
KELLY A MANICKE
Active
Individual
KELLY A MANICKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28164416
IN
363L00000X
Nurse Practitioner
71002746A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71002746A
IN
Other
Enumeration date
09/16/2008
Last updated
04/30/2018
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