Provider Demographics
NPI:1356686851
Name:EMERSON, SAMANTHA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:EMERSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:LECHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:615 S NEW BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8221
Mailing Address - Country:US
Mailing Address - Phone:314-251-7955
Mailing Address - Fax:314-251-7797
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-7955
Practice Address - Fax:314-251-7797
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001513176B00000X
MO2014034808176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife