Provider Demographics
NPI:1992836662
Name:PAUL, SAMANTHA NANNETTE (STNA)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:NANNETTE
Last Name:PAUL
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5678 RUSSIA VERSAILLES RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45333-9732
Mailing Address - Country:US
Mailing Address - Phone:937-615-0083
Mailing Address - Fax:937-615-0083
Practice Address - Street 1:5678 RUSSIA VERSAILLES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:OH
Practice Address - Zip Code:45333-9732
Practice Address - Country:US
Practice Address - Phone:937-615-0083
Practice Address - Fax:937-615-0083
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400394470804374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2553606Medicaid