Provider Demographics
NPI:1396004826
Name:SCHMITTINGER, SAMANTHA SARAH
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SARAH
Last Name:SCHMITTINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:SARAH
Other - Last Name:SYBRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-0245
Mailing Address - Country:US
Mailing Address - Phone:262-442-8377
Mailing Address - Fax:
Practice Address - Street 1:667 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3843
Practice Address - Country:US
Practice Address - Phone:262-442-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WITBA164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse