Provider Demographics
NPI:1235806928
Name:WEBER, SAMANTHA (NP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:SCHERMEISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-546-2992
Mailing Address - Fax:414-546-2996
Practice Address - Street 1:6030 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-4133
Practice Address - Country:US
Practice Address - Phone:414-546-2992
Practice Address - Fax:414-546-2996
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11181363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100180821Medicaid