Provider Demographics
NPI:1508039223
Name:ALLEN, SAMANTHA A (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 67
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526-9705
Mailing Address - Country:US
Mailing Address - Phone:406-353-3235
Mailing Address - Fax:406-353-3283
Practice Address - Street 1:456 GROS VENTRE AVENUE
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-0456
Practice Address - Country:US
Practice Address - Phone:406-353-3235
Practice Address - Fax:406-353-3283
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT35831163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health