MEDICARE: SAMANTHA HELENA NEAMONITIS

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	363LA2200X	Adult Health Nurse Practitioner	4704353789	MI

General Provider Information

NPI Number	:	1669359501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA HELENA NEAMONITIS

Provider Business Mailing Address
First Line	:	18529 DOGWOOD
Second Line	:
City	:	FRASER
State	:	MI
Zip	:	48026-2133
Country	:	US
Telephone Number	:	586-899-7011
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 W MAPLE RD
Second Line	:
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48301-3148
Country	:	US
Telephone Number	:	248-480-4402
Fax Number	:

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

Provider Enumeration Date	:	08/20/2025
Last Update Date	:	08/20/2025

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