Individual
KIM MANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
4600 MEMORIAL DR STE 200, BELLEVILLE, IL 62226-5363
(618) 233-2220
Mailing address
4600 MEMORIAL DR STE 200, BELLEVILLE, IL 62226-5363
(618) 233-2220
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209007723
IL
363LA2100X
Acute Care Nurse Practitioner
209.007723
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
209007723
IL
Other
Enumeration date
11/09/2009
Last updated
03/21/2022
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