MEDICARE: SAMANTHA MARIE MACINO CNP

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	163W00000X	Registered Nurse	441652	OH
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	441652	OH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0031760	OH

General Provider Information

NPI Number	:	1285116533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MARIE MACINO CNP

Provider Business Mailing Address
First Line	:	2407 S LINDEN AVE
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-5156
Country	:	US
Telephone Number	:	937-304-2506
Fax Number	:

Provider Business Practice Location Address
First Line	:	2407 S LINDEN AVE
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-5156
Country	:	US
Telephone Number	:	937-304-2506
Fax Number	:

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

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	12/02/2022

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