Provider Demographics
NPI:1437187085
Name:SAMPSEL, CECILIA JEAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:JEAN
Last Name:SAMPSEL
Suffix:
Gender:F
Credentials:NP
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 20
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-0020
Mailing Address - Country:US
Mailing Address - Phone:219-987-3581
Mailing Address - Fax:219-987-7137
Practice Address - Street 1:520 EIGHTH AVE N.E
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310
Practice Address - Country:US
Practice Address - Phone:219-987-3581
Practice Address - Fax:219-987-7137
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000106A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN390380EMedicare ID - Type Unspecified
INS56281Medicare UPIN