Provider Demographics
NPI:1225400070
Name:SHOULTZ, SAMANTHA ELAINE (NP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELAINE
Last Name:SHOULTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 VENETIAN WAY
Mailing Address - Street 2:ST 2
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630
Mailing Address - Country:US
Mailing Address - Phone:812-999-3277
Mailing Address - Fax:812-518-1722
Practice Address - Street 1:3922 VENETIAN WAY
Practice Address - Street 2:ST 2
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630
Practice Address - Country:US
Practice Address - Phone:812-999-3277
Practice Address - Fax:812-518-1722
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28224617A163W00000X
IN71010484A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse