Provider Demographics
NPI:1619749595
Name:WAPPENSTEIN, SAMANTHA BAILEY
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BAILEY
Last Name:WAPPENSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SAPELE DR APT D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-4737
Mailing Address - Country:US
Mailing Address - Phone:937-244-0449
Mailing Address - Fax:
Practice Address - Street 1:1604 SAPELE DR APT D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-4737
Practice Address - Country:US
Practice Address - Phone:937-244-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide