Provider Demographics
NPI:1225481013
Name:WOJCIK, SAMANTHA KATHERINE (FNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATHERINE
Last Name:WOJCIK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:KATHERINE
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6375 US HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5218
Mailing Address - Country:US
Mailing Address - Phone:219-762-3196
Mailing Address - Fax:219-763-6438
Practice Address - Street 1:6375 US HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5218
Practice Address - Country:US
Practice Address - Phone:219-762-3196
Practice Address - Fax:219-763-6438
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28203495A363LF0000X
IN71006384A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201384100Medicaid