Basic Information
Provider Information
NPI: 1316314412
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MANCHIN
FirstName: SCARLETT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3377 US ROUTE 60
Address2:  
City: HUNTINGTON
State: WV
PostalCode: 257052837
CountryCode: US
TelephoneNumber: 3045253334
FaxNumber: 3045253338
Practice Location
Address1: 3377 US ROUTE 60
Address2:  
City: HUNTINGTON
State: WV
PostalCode: 257052837
CountryCode: US
TelephoneNumber: 3043993310
FaxNumber: 3045235416
Other Information
ProviderEnumerationDate: 08/25/2015
LastUpdateDate: 06/01/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X71024WVN Nursing Service ProvidersRegistered Nurse 
363LF0000XAPRN71024-FNPBCWVY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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