=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275310377
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANAR KHALIL APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2023
-----------------------------------------------------
Last Update Date | 03/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 REGENT ST STE 200
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43219-6229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-870-1775
-----------------------------------------------------
Fax | 614-968-8840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1845 S MICHIGAN AVE UNIT 1803
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60616-3593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-239-1843
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 11028560
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 209.028327
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------