Provider Demographics
NPI:1336806421
Name:MACKIN, SAMANTHA MARY (CRNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARY
Last Name:MACKIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:M
Other - Last Name:WINICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 WATERDAM PLAZA DR STE 240
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5427
Mailing Address - Country:US
Mailing Address - Phone:724-941-2018
Mailing Address - Fax:724-941-2093
Practice Address - Street 1:1000 WATERDAM PLAZA DR STE 240
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5427
Practice Address - Country:US
Practice Address - Phone:724-941-2018
Practice Address - Fax:724-941-2093
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily