Healthcare Provider Details

I. General information

NPI: 1285748814
Provider Name (Legal Business Name): SAMANTHA ALEXIS VOLSTORF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E COURT ST
PARIS IL
61944-2460
US

IV. Provider business mailing address

721 E COURT ST
PARIS IL
61944-2460
US

V. Phone/Fax

Practice location:
  • Phone: 217-465-4141
  • Fax: 217-463-2769
Mailing address:
  • Phone: 217-465-4141
  • Fax: 217-463-2769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002156A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209009354
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-009354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: