Provider Demographics
NPI:1134761216
Name:LOMMASSON, SAMANTHA J (CPM, DEM)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:LOMMASSON
Suffix:
Gender:F
Credentials:CPM, DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 OLD CORVALLIS RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3123
Mailing Address - Country:US
Mailing Address - Phone:406-361-0327
Mailing Address - Fax:406-540-1221
Practice Address - Street 1:813 S 1ST ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3015
Practice Address - Country:US
Practice Address - Phone:064-361-0327
Practice Address - Fax:406-540-1221
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-LIC-MID-2568176B00000X
IDMID-99176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty