Healthcare Provider Details

I. General information

NPI: 1770934903
Provider Name (Legal Business Name): SAMANTHA ROSE LEHMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTA ROSE HILKER

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 11/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 INSURANCE DR
FORT WAYNE IN
46825-4252
US

IV. Provider business mailing address

1913 LA VISTA DR
WARSAW IN
46580-4948
US

V. Phone/Fax

Practice location:
  • Phone: 866-434-3255
  • Fax: 833-673-0254
Mailing address:
  • Phone: 574-529-1588
  • Fax: 574-335-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28203792A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: