Provider Demographics
NPI:1558599258
Name:SMITH, SAMANTHA RAE (BS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NW 4TH ST
Mailing Address - Street 2:SUITE B-7
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1350
Mailing Address - Country:US
Mailing Address - Phone:812-421-0059
Mailing Address - Fax:812-424-9059
Practice Address - Street 1:201 NW 4TH ST
Practice Address - Street 2:SUITE B-7
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1350
Practice Address - Country:US
Practice Address - Phone:812-421-0059
Practice Address - Fax:812-424-9059
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator