Provider Demographics
NPI:1851017966
Name:NAMLIK, SAMANTHA JO (FNP-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:NAMLIK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:632 COOPER LN
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:WV
Mailing Address - Zip Code:26055-1375
Mailing Address - Country:US
Mailing Address - Phone:304-280-1767
Mailing Address - Fax:
Practice Address - Street 1:800 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1660
Practice Address - Country:US
Practice Address - Phone:304-845-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114666363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner