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General NPI Number Information
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NPI Number | 1720800238
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Entity Type | Individual
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Provider Name | SAMANTHA MARIE MANSO NP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2024
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Last Update Date | 10/26/2024
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Provider Practice Location Address
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Address Line | 4817 W 83RD ST
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City | BURBANK
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State | IL
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Zip | 60459-2790
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Country | US
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Telephone | 708-966-6241
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Fax |
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Provider Business Mailing Address
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Address Line | 5716 S RUTHERFORD AVE
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City | CHICAGO
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State | IL
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Zip | 60638-3237
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Country | US
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Telephone | 773-606-4553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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