Healthcare Provider Details

I. General information

NPI: 1285485284
Provider Name (Legal Business Name): SAMANTHA RUSCHAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7763 MONTGOMERY RD
CINCINNATI OH
45236-4201
US

IV. Provider business mailing address

6847 STEWART RD APT 408
CINCINNATI OH
45236-0717
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-5438
  • Fax:
Mailing address:
  • Phone: 724-972-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP029493
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0038697
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: