Provider Demographics
NPI:1760146625
Name:PELL, SAMANTHA RACHEL (APN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RACHEL
Last Name:PELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:RACHEL
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:4205 WESTBROOK DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4124
Practice Address - Country:US
Practice Address - Phone:630-527-1818
Practice Address - Fax:630-527-1244
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041439099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner