Provider Demographics
NPI:1588852347
Name:SAMANAS, JUSTINE M (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:M
Last Name:SAMANAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:M
Other - Last Name:SPRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3702
Mailing Address - Country:US
Mailing Address - Phone:570-288-5441
Mailing Address - Fax:570-288-5842
Practice Address - Street 1:128 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-3113
Practice Address - Country:US
Practice Address - Phone:570-735-3300
Practice Address - Fax:570-735-1879
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant