Provider Demographics
NPI:1770137440
Name:SAMLUCK, JAIME (CRNP-PC, IBCLC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:SAMLUCK
Suffix:
Gender:F
Credentials:CRNP-PC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 JERMOR LN STE 105
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6152
Mailing Address - Country:US
Mailing Address - Phone:410-871-1000
Mailing Address - Fax:
Practice Address - Street 1:511 JERMOR LN STE 105
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6152
Practice Address - Country:US
Practice Address - Phone:410-871-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL-121368163WL0100X
MDR206790363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant