Samantha Jo Mangiaracina

Primary specialty

Critical Care Medicine Registered NurseTaxonomy code 163WC0200X

License

2018003563 Issued in MO

Practice address

841 SW Harvest Dr
Grain Valley, MO 64029-9380

Phone

(816) 217-9898

NPI assigned

Jun 15, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Samantha Jo Anderson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1477283927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 SW HARVEST DR",
            "city": "GRAIN VALLEY",
            "state": "MO",
            "postal_code": "640299380",
            "telephone_number": "816-217-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 SW HARVEST DR",
            "city": "GRAIN VALLEY",
            "state": "MO",
            "postal_code": "640299380",
            "telephone_number": "816-217-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGIARACINA",
        "first_name": "SAMANTHA",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-15",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "MO",
            "license": "2018003563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "ANDERSON",
            "middle_name": "JO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Critical Care Medicine Registered Nurse in Grain Valley, MO
• Providers in Grain Valley, MO by specialty
• Critical Care Medicine Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.