MEDICARE: SAMANTHA MANIFOR APRN, FNP- C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0037948	OH

General Provider Information

NPI Number	:	1003638172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MANIFOR APRN, FNP- C

Provider Business Mailing Address
First Line	:	4719 WIDNER CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3156
Country	:	US
Telephone Number	:	937-520-8657
Fax Number	:

Provider Business Practice Location Address
First Line	:	4719 WIDNER CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3156
Country	:	US
Telephone Number	:	937-520-8657
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

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