Provider Demographics
NPI:1952881724
Name:BROWN, SAMANTHA KAY
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAY
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SURFSIDE DR APT 121
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68528-1081
Mailing Address - Country:US
Mailing Address - Phone:308-340-6523
Mailing Address - Fax:
Practice Address - Street 1:511 SURFSIDE DRIVE
Practice Address - Street 2:APATMENT 121
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68528-6852
Practice Address - Country:US
Practice Address - Phone:308-340-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician