Provider Demographics
NPI:1508533951
Name:HERMAN, SAMANTHA DAWN (MSN, APN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DAWN
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MSN, APN, CPNP-PC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:DAWN
Other - Last Name:ACHONYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:27 HYLAND DR
Practice Address - Street 2:
Practice Address - City:LAKE LUZERNE
Practice Address - State:NY
Practice Address - Zip Code:12846-3923
Practice Address - Country:US
Practice Address - Phone:518-824-2580
Practice Address - Fax:518-824-2579
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF383312363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06777444Medicaid