Provider Demographics
NPI:1790380558
Name:MARTY, SAMANTHA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MARTY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CHAMBERS CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:WV
Mailing Address - Zip Code:26180-3585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 CHAMBERS CIRCLE RD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:WV
Practice Address - Zip Code:26180-3585
Practice Address - Country:US
Practice Address - Phone:888-771-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0026794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily