MEDICARE: SAMANTHA A PAVLICK WHNP-BC, CNM, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	SP010693	PA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP021855	PA

General Provider Information

NPI Number	:	1295984367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA A PAVLICK WHNP-BC, CNM, PMHNP

Provider Business Mailing Address
First Line	:	200 OLD POND RD STE 107
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-1269
Country	:	US
Telephone Number	:	412-319-7866
Fax Number	:	412-914-8635

Provider Business Practice Location Address
First Line	:	200 OLD POND RD STE 107
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-1269
Country	:	US
Telephone Number	:	412-319-7866
Fax Number	:	412-914-8635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	04/23/2025

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