Healthcare Provider Details

I. General information

NPI: 1831064849
Provider Name (Legal Business Name): SAMANTHA CHYKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PARKSIDE ST UNIT 151
TIFFIN IA
52340-7607
US

IV. Provider business mailing address

584 250TH ST
WEST BRANCH IA
52358-8533
US

V. Phone/Fax

Practice location:
  • Phone: 319-383-3830
  • Fax:
Mailing address:
  • Phone: 319-383-3830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09250678
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: