Provider Demographics
NPI:1801760657
Name:WEILER, SAMANTHA RAE ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAE ANN
Last Name:WEILER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 N PROMENADE CIR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-8287
Mailing Address - Country:US
Mailing Address - Phone:219-221-0051
Mailing Address - Fax:
Practice Address - Street 1:501 ALLEN CT STE 1101
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-0323
Practice Address - Country:US
Practice Address - Phone:219-786-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28266567A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty