Provider Demographics
NPI:1609543248
Name:KORI NKENLIFACK MANHENKEU, NATHALIE ROSINE (FNP)
Entity Type:Individual
Prefix:
First Name:NATHALIE ROSINE
Middle Name:
Last Name:KORI NKENLIFACK MANHENKEU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 OGELTHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-4749
Mailing Address - Country:US
Mailing Address - Phone:217-819-7328
Mailing Address - Fax:
Practice Address - Street 1:1409 OGELTHORPE AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-4749
Practice Address - Country:US
Practice Address - Phone:217-819-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily