Provider Demographics
NPI:1588778013
Name:MANSKE, CONNIE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:LYNN
Last Name:MANSKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:MMC 736 UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6100
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE STREET SE
Practice Address - Street 2:PWB, CLINIC 2A UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30481207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31620100Medicaid
IA0501452Medicaid
ND10387Medicaid
31-24693OtherMEDICA - CHOICE
MN368285400Medicaid
MT0055289Medicaid
1009229OtherPREFERREDONE
101482OtherUCARE
768245OtherARAZ
MN2T161MAOtherBLUE CROSS BLUE SHIELD
31-00005OtherMEDICA - PRIMARY
SD7777470Medicaid
HP22165OtherHEALTHPARTNERS
ND10387Medicaid
MN368285400Medicaid
31-24693OtherMEDICA - CHOICE