Provider Demographics
NPI:1053835363
Name:CICHON, SAMANTHA LYNN (RN, MSN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNN
Last Name:CICHON
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 RIVERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NJ
Mailing Address - Zip Code:08065-2149
Mailing Address - Country:US
Mailing Address - Phone:856-534-4829
Mailing Address - Fax:
Practice Address - Street 1:100 BOWMAN DR FL 2
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9612
Practice Address - Country:US
Practice Address - Phone:856-988-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17753800163WP0200X
NJ26NJ00780300367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WP0200XNursing Service ProvidersRegistered NursePediatrics