Healthcare Provider Details

I. General information

NPI: 1962659516
Provider Name (Legal Business Name): BARBARA E SAMMONS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LINCOLN PARK BLVD SUITE 200
KETTERING OH
45429-3492
US

IV. Provider business mailing address

500 LINCOLN PARK BLVD SUITE 200
KETTERING OH
45429-3492
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-5567
  • Fax:
Mailing address:
  • Phone: 937-293-5567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN271174
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: