Provider Demographics
NPI:1083336671
Name:DELLINGER, SAMANTHA BRIANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BRIANNE
Last Name:DELLINGER
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 1:1238 CHILDS RD W APT 76
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-4474
Mailing Address - Country:US
Mailing Address - Phone:402-332-8474
Mailing Address - Fax:
Practice Address - Street 1:42ND AND EMILE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-4474
Practice Address - Country:US
Practice Address - Phone:402-332-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program