Individual provider · Type 1 NPI
Vyacheslav Mamanov, NP
Adult Health Nurse Practitioner · Forest Hills, NY
NPI number
1154095677
Active
Practice location
10218 64th Ave
Forest Hills, NY 11375-1548
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Health Nurse Practitioner Primary | 363LA2200X | 310305 (NY) |
Adult Health Nurse Practitioner: Definition to come...
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About NPI 1154095677
Vyacheslav Mamanov, NP's National Provider Identifier is 1154095677, issued on Aug 7, 2021. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in Forest Hills, NY. The record was last updated on Aug 7, 2021.