Healthcare Provider Details

I. General information

NPI: 1467390369
Provider Name (Legal Business Name): SAMANTHA RARDIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MEMORIAL DR
BELLEVILLE IL
62226-5399
US

IV. Provider business mailing address

5238 BISCHOFF AVE APT 1
SAINT LOUIS MO
63110-3120
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-7750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041570571
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: