Basic Information
| Provider Information | |||||||||
| NPI: | 1770026569 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANCINI | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MADELINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HASSAY | ||||||||
| OtherFirstName: | LAURA | ||||||||
| OtherMiddleName: | MADELINE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 715 E WESTERN RESERVE RD | ||||||||
| Address2: | |||||||||
| City: | POLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445143358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307263204 | ||||||||
| FaxNumber: | 3307299316 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 E WESTERN RESERVE RD | ||||||||
| Address2: | |||||||||
| City: | POLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445143358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307263204 | ||||||||
| FaxNumber: | 3307299316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2016 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | APRN.CNP.19129 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.