Healthcare Provider Details

I. General information

NPI: 1932889789
Provider Name (Legal Business Name): SAMANTHA SONTICH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 08/26/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W WHITE RIVER BLVD
MUNCIE IN
47303-5263
US

IV. Provider business mailing address

PO BOX 1676
MUNCIE IN
47308-1676
US

V. Phone/Fax

Practice location:
  • Phone: 765-286-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71015609A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: