Provider Demographics
NPI:1073793618
Name:BEMRICH, SAMANTHA LORENE (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LORENE
Last Name:BEMRICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4189 WESTLAWN S
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1100
Mailing Address - Country:US
Mailing Address - Phone:319-335-8370
Mailing Address - Fax:319-335-7247
Practice Address - Street 1:4189 WESTLAWN S
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1100
Practice Address - Country:US
Practice Address - Phone:319-335-8370
Practice Address - Fax:319-335-7247
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3729363A00000X
IA002255363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant