Provider Demographics
NPI:1164040754
Name:MANLEY, KALI M (RN)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:M
Last Name:MANLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX P
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-0520
Mailing Address - Country:US
Mailing Address - Phone:402-269-2383
Mailing Address - Fax:402-269-2224
Practice Address - Street 1:550 7TH STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446
Practice Address - Country:US
Practice Address - Phone:402-269-2383
Practice Address - Fax:402-269-2224
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE82097163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE82097Medicaid