Provider Demographics
NPI:1255909560
Name:TALLMAN, SAMANTHA E (DNP)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:E
Last Name:TALLMAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:E
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 776982
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1560 E SHERMAN BLVD
Practice Address - Street 2:STE 250
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-672-8145
Practice Address - Fax:231-672-6179
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704347167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily