Provider Demographics
NPI:1558574160
Name:SCHAEFER, SAMANTHA (MS, RD, LD, FAND)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MS, RD, LD, FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 S PINE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3412
Mailing Address - Country:US
Mailing Address - Phone:812-856-2761
Mailing Address - Fax:
Practice Address - Street 1:2721 S PINE MEADOWS DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3412
Practice Address - Country:US
Practice Address - Phone:812-856-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001690A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN37001690AOtherSTATE LICENSE