Provider Demographics
NPI:1164272746
Name:ELDER, SAMANTHA (LPN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ELDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 ELDER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TN
Mailing Address - Zip Code:37322-7219
Mailing Address - Country:US
Mailing Address - Phone:142-332-2234
Mailing Address - Fax:
Practice Address - Street 1:608 ELDER HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322-7219
Practice Address - Country:US
Practice Address - Phone:142-332-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85724164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse