Provider Demographics
NPI:1194130633
Name:MANCUSO, KERRY CATHERINE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:CATHERINE
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 N 62ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4052
Mailing Address - Country:US
Mailing Address - Phone:402-980-2535
Mailing Address - Fax:
Practice Address - Street 1:987400 NEBRASKA MEDICAL CTR
Practice Address - Street 2:UNIVERSITY TOWER 8100 ZIP: 2465
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-7400
Practice Address - Country:US
Practice Address - Phone:402-559-8592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111665363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care