Provider Demographics
NPI:1447795331
Name:JOSEN, SAMANTHA KOHEN (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KOHEN
Last Name:JOSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1314
Mailing Address - Country:US
Mailing Address - Phone:847-612-1830
Mailing Address - Fax:
Practice Address - Street 1:3021 FALLING WATERS BLVD STE A
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-6745
Practice Address - Country:US
Practice Address - Phone:847-356-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant