Provider Demographics
NPI:1568013928
Name:WALTON, SAMANTHA (FNP-BC, NP-C,)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:FNP-BC, NP-C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 MATTHEW LN APT C3
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2873
Mailing Address - Country:US
Mailing Address - Phone:773-416-3128
Mailing Address - Fax:
Practice Address - Street 1:3010 MATTHEW LN APT C3
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2873
Practice Address - Country:US
Practice Address - Phone:773-416-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF08180978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily