Healthcare Provider Details

I. General information

NPI: 1811663529
Provider Name (Legal Business Name): SAMANTHA J O'NEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17037 W 143RD ST
LOCKPORT IL
60441-9424
US

IV. Provider business mailing address

17037 W 143RD ST
LOCKPORT IL
60441-9424
US

V. Phone/Fax

Practice location:
  • Phone: 708-307-9268
  • Fax:
Mailing address:
  • Phone: 708-307-9268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209030287
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.455656
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: