Provider Demographics
NPI:1700662996
Name:ROEHM, SAMANTHA SHARON (LPN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SHARON
Last Name:ROEHM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-2304
Mailing Address - Country:US
Mailing Address - Phone:315-212-3298
Mailing Address - Fax:
Practice Address - Street 1:242 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1122
Practice Address - Country:US
Practice Address - Phone:315-764-8076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347288164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse