Provider Demographics
NPI:1245882414
Name:MILLER, SAMANTHA ANN
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ANN
Other - Last Name:GRAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5274 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7833
Mailing Address - Country:US
Mailing Address - Phone:242-160-3177
Mailing Address - Fax:
Practice Address - Street 1:5274 ROUTE 30 STE 10
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7831
Practice Address - Country:US
Practice Address - Phone:724-216-0317
Practice Address - Fax:724-837-0271
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily