Provider Demographics
NPI:1831641679
Name:MANTEI, BENJAMIN (CNP)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:MANTEI
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8129 TIMOTHY LN
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 EBER RD
Practice Address - Street 2:ST. E
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9793
Practice Address - Country:US
Practice Address - Phone:419-866-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019998363LF0000X
MI4704286708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily