Provider Demographics
NPI:1043996200
Name:DILLMAN, SAMANTHA PAIGE (RN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PAIGE
Last Name:DILLMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:PAIGE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9154 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-7416
Mailing Address - Country:US
Mailing Address - Phone:304-733-9430
Mailing Address - Fax:
Practice Address - Street 1:9154 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:ONA
Practice Address - State:WV
Practice Address - Zip Code:25545-7416
Practice Address - Country:US
Practice Address - Phone:304-733-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV113734163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health