Provider Demographics
NPI:1295434645
Name:MANUEL, CODY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:MANUEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 E MCKNIGHT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1915
Mailing Address - Country:US
Mailing Address - Phone:316-706-9707
Mailing Address - Fax:
Practice Address - Street 1:1836 E MCKNIGHT ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1915
Practice Address - Country:US
Practice Address - Phone:316-706-9707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS141336163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency