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General NPI Number Information
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NPI Number | 1730819954
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Entity Type | Individual
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Provider Name | FREDERIC MANIRAHO MSN, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/11/2022
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Last Update Date | 11/29/2024
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Provider Practice Location Address
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Address Line | 4755 OGLETOWN STANTON ROAD SUITE 2E99
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City | NEWARK
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State | DE
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Zip | 19718-2200
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Country | US
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Telephone | 302-733-5982
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Fax | 302-733-6081
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Provider Business Mailing Address
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Address Line | 120 E WINONA CIR
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City | NORWOOD
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State | PA
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Zip | 19074-1123
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Country | US
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Telephone | 215-715-7987
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | L1-0074494
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | LP-0010813
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | LP-0010813
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LP-0010813
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License Number State | DE
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Taxonomy #5
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 703160
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License Number State | PA
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