Provider Demographics
NPI:1619564119
Name:LANSBERRY, SAMANTHA ELIZABETH (MPH, RD, LDN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:LANSBERRY
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LANDISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17538-1346
Mailing Address - Country:US
Mailing Address - Phone:717-330-5326
Mailing Address - Fax:
Practice Address - Street 1:3107 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:LANDISVILLE
Practice Address - State:PA
Practice Address - Zip Code:17538-1346
Practice Address - Country:US
Practice Address - Phone:717-330-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered