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General NPI Number Information
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NPI Number | 1942089768
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Entity Type | Individual
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Provider Name | SAMANTHA L MUNRO
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Gender | Female
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 2236 VADALABENE DR
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City | MARYVILLE
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State | IL
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Zip | 62062-5844
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Country | US
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Telephone | 618-726-2229
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Fax |
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Provider Business Mailing Address
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Address Line | 726 SUNSET BLVD
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City | OFALLON
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State | IL
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Zip | 62269
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Country | US
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Telephone | 618-726-2229
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209028045
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License Number State | IL
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