Provider Demographics
NPI:1912677097
Name:MANZ, KALI SUSAN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KALI
Middle Name:SUSAN
Last Name:MANZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:503 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HENDRICKS
Mailing Address - State:MN
Mailing Address - Zip Code:56136-9598
Mailing Address - Country:US
Mailing Address - Phone:507-275-2218
Mailing Address - Fax:507-275-2242
Practice Address - Street 1:503 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HENDRICKS
Practice Address - State:MN
Practice Address - Zip Code:56136-9598
Practice Address - Country:US
Practice Address - Phone:507-275-2218
Practice Address - Fax:507-275-2242
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN8530363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology