Healthcare Provider Details

I. General information

NPI: 1114668431
Provider Name (Legal Business Name): SAMANTHA LYNN WINTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2003
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVENUE, ML 2003
CINCINNATI OH
45229-4421
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4007
  • Fax:
Mailing address:
  • Phone: 513-636-4432
  • Fax: 513-636-3952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0030425
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0030425
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: