Individual
MANICIA SHUNDREAL LIDDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
911 NORTHLAND DR, PRINCETON, MN 55371-2172
(763) 389-1313
Mailing address
911 NORTHLAND DR, PRINCETON, MN 55371-2172
(763) 389-1313
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
200056
LA
363L00000X
Nurse Practitioner
347087
NY
363L00000X
Nurse Practitioner
Primary
8995
MN
363L00000X
Nurse Practitioner
LIDD-8T8QP1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LIDD-8T8QP1
ADVANCED NURSING LICENSE
MS
Enumeration date
02/22/2018
Last updated
03/13/2026
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