Healthcare Provider Details

I. General information

NPI: 1720969678
Provider Name (Legal Business Name): MRS. SAMANTHA NICOLLE BECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 10/24/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SUNBURY ST
MINERSVILLE PA
17954-1346
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 570-544-9123
  • Fax: 570-544-9263
Mailing address:
  • Phone: 570-544-9123
  • Fax: 570-544-9263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP034141
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN678023
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: