Provider Demographics
NPI:1477283927
Name:MANGIARACINA, SAMANTHA JO
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JO
Last Name:MANGIARACINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:841 SW HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-9380
Mailing Address - Country:US
Mailing Address - Phone:816-217-9898
Mailing Address - Fax:
Practice Address - Street 1:841 SW HARVEST DR
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-9380
Practice Address - Country:US
Practice Address - Phone:816-217-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018003563163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine