Individual
FAITH A. MANTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
4572 COUNTY ROAD 61, MOOSE LAKE, MN 55767-9401
(218) 485-4481
(218) 485-5866
Mailing address
4572 COUNTY ROAD 61, MOOSE LAKE, MN 55767-9401
(218) 485-4481
(218) 485-5866
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
722
MN
363LF0000X
Family Nurse Practitioner
R 137363-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
894967000
—
MN
Enumeration date
07/26/2007
Last updated
03/26/2020
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