Healthcare Provider Details

I. General information

NPI: 1811836257
Provider Name (Legal Business Name): SAMANTHA STARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5509 S 31ST ST APT 8
LINCOLN NE
68516-2023
US

IV. Provider business mailing address

5509 S 31ST ST APT 8
LINCOLN NE
68516-2023
US

V. Phone/Fax

Practice location:
  • Phone: 402-613-1966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number155348
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: