Healthcare Provider Details

I. General information

NPI: 1063281632
Provider Name (Legal Business Name): SAMANTHA CLINE FLUCKIGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA CLINE

II. Dates (important events)

Enumeration Date: 12/25/2023
Last Update Date: 12/25/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 BERKLEY AVE
EAST CARBON UT
84520-7733
US

IV. Provider business mailing address

PO BOX 87
EAST CARBON UT
84520-0087
US

V. Phone/Fax

Practice location:
  • Phone: 435-299-0331
  • Fax:
Mailing address:
  • Phone: 435-299-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number011615001345
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: