Provider Demographics
NPI:1295906410
Name:SCHIRMER, SAMANTHA ANN
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:SCHIRMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27882 STATE ROUTE 342 LOT 217
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:13612-2123
Mailing Address - Country:US
Mailing Address - Phone:315-775-0526
Mailing Address - Fax:
Practice Address - Street 1:27882 STATE ROUTE 342 LOT 217
Practice Address - Street 2:
Practice Address - City:BLACK RIVER
Practice Address - State:NY
Practice Address - Zip Code:13612-2123
Practice Address - Country:US
Practice Address - Phone:315-775-0526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273282-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02553473Medicaid