Healthcare Provider Details

I. General information

NPI: 1013854553
Provider Name (Legal Business Name): SAMANTHA POPOVICH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 LINDELL RD # D393
LAS VEGAS NV
89103-1254
US

IV. Provider business mailing address

3651 LINDELL RD # D393
LAS VEGAS NV
89103-1254
US

V. Phone/Fax

Practice location:
  • Phone: 847-721-4663
  • Fax:
Mailing address:
  • Phone: 847-721-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number813374
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: