Provider Demographics
NPI:1578948428
Name:MCMANUS, KRISTA L (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:L
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E 37TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2971
Mailing Address - Country:US
Mailing Address - Phone:218-208-0019
Mailing Address - Fax:218-305-4630
Practice Address - Street 1:1101 E 37TH ST STE 5
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2971
Practice Address - Country:US
Practice Address - Phone:218-208-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2015000656363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health