Provider Demographics
NPI:1457336406
Name:FIL, SAMANTHA LAURELIN (NP)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LAURELIN
Last Name:FIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LAURELIN
Other - Last Name:DREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1541
Mailing Address - Country:US
Mailing Address - Phone:719-556-5898
Mailing Address - Fax:
Practice Address - Street 1:559 VINCENT ST
Practice Address - Street 2:SPACE BASE DELTA 1
Practice Address - City:PETERSON SPACE FORCE BASE
Practice Address - State:CO
Practice Address - Zip Code:80914-1541
Practice Address - Country:US
Practice Address - Phone:719-556-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8293363LA2100X
TXAP135341363LA2100X
NVAPRN001821363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COUSAFA VAD006Medicare UPIN