MEDICARE: SAMANTHA ROSE SUMAIT DNP, FNP-BC

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	363LF0000X	Family Nurse Practitioner	209028448	IL

General Provider Information

NPI Number	:	1922703388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ROSE SUMAIT DNP, FNP-BC

Provider Business Mailing Address
First Line	:	17 N STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-3315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 N STATE ST # TE500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-3315
Country	:	US
Telephone Number	:	773-252-2240
Fax Number	:

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

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	05/06/2024

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