Provider Demographics
NPI:1336278753
Name:MANN, NIKKI J (GNP-C)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:J
Last Name:MANN
Suffix:
Gender:F
Credentials:GNP-C
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Mailing Address - Street 1:3010 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-1328
Mailing Address - Country:US
Mailing Address - Phone:260-478-6240
Mailing Address - Fax:260-527-4802
Practice Address - Street 1:3010 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-1328
Practice Address - Country:US
Practice Address - Phone:260-739-5821
Practice Address - Fax:260-527-4802
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2018-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28157094A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology