Provider Demographics
NPI:1407177637
Name:BAAB, SAMANTHA JD (NP-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JD
Last Name:BAAB
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W CHUBBUCK RD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2315
Mailing Address - Country:US
Mailing Address - Phone:208-237-7911
Mailing Address - Fax:208-237-3450
Practice Address - Street 1:134 W CHUBBUCK RD
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2315
Practice Address - Country:US
Practice Address - Phone:208-237-7911
Practice Address - Fax:208-237-3450
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-982A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily