Healthcare Provider Details

I. General information

NPI: 1225481013
Provider Name (Legal Business Name): SAMANTHA KATHERINE WOJCIK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA KATHERINE CURTIS

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 US HIGHWAY 6
PORTAGE IN
46368-5218
US

IV. Provider business mailing address

6375 US HIGHWAY 6
PORTAGE IN
46368-5218
US

V. Phone/Fax

Practice location:
  • Phone: 219-762-3196
  • Fax: 219-763-6438
Mailing address:
  • Phone: 219-762-3196
  • Fax: 219-763-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28203495A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006384A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: