Healthcare Provider Details

I. General information

NPI: 1831081413
Provider Name (Legal Business Name): SAMANTHA J YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6418 DEANS HILL RD STE 1
BERRIEN CENTER MI
49102-8714
US

IV. Provider business mailing address

6418 DEANS HILL RD STE 1
BERRIEN CENTER MI
49102-8714
US

V. Phone/Fax

Practice location:
  • Phone: 269-815-5500
  • Fax: 269-815-5373
Mailing address:
  • Phone: 269-815-5500
  • Fax: 269-815-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: