Provider Demographics
NPI:1407526189
Name:BROWN ELDRIDGE, SAMARA LYNN
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:LYNN
Last Name:BROWN ELDRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2321
Mailing Address - Country:US
Mailing Address - Phone:330-531-0965
Mailing Address - Fax:
Practice Address - Street 1:111 N HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2321
Practice Address - Country:US
Practice Address - Phone:330-531-0965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide