Healthcare Provider Details

I. General information

NPI: 1881500650
Provider Name (Legal Business Name): SAMANTHA VON PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

IV. Provider business mailing address

113 W YORK ST
CAMP POINT IL
62320-1320
US

V. Phone/Fax

Practice location:
  • Phone: 217-223-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number041480917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: