Provider Demographics
NPI:1417562570
Name:HAMER, SAMANTHA NICOLE (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:HAMER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:GALLITZIN
Mailing Address - State:PA
Mailing Address - Zip Code:16641-0037
Mailing Address - Country:US
Mailing Address - Phone:814-312-7120
Mailing Address - Fax:
Practice Address - Street 1:127 WALNUT ST
Practice Address - Street 2:
Practice Address - City:COUPON
Practice Address - State:PA
Practice Address - Zip Code:16629-8418
Practice Address - Country:US
Practice Address - Phone:814-312-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAG09200020363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health