Provider Demographics
NPI:1649976416
Name:VANVOORHIS, SAMANTHA LYN (APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYN
Last Name:VANVOORHIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:79 WAWECUS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2173
Mailing Address - Country:US
Mailing Address - Phone:860-886-1862
Mailing Address - Fax:860-886-2046
Practice Address - Street 1:79 WAWECUS ST STE 103
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2173
Practice Address - Country:US
Practice Address - Phone:860-886-1862
Practice Address - Fax:860-886-2046
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT11545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily