Provider Demographics
NPI:1013257146
Name:STUMPP, SAMANTHA ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANN
Last Name:STUMPP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:ANN
Other - Last Name:KENSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:29 MALVERNE RD
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-2915
Mailing Address - Country:US
Mailing Address - Phone:631-846-1844
Mailing Address - Fax:
Practice Address - Street 1:29 MALVERNE RD
Practice Address - Street 2:
Practice Address - City:SOUND BEACH
Practice Address - State:NY
Practice Address - Zip Code:11789-2915
Practice Address - Country:US
Practice Address - Phone:631-704-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302526164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse