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General NPI Number Information
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NPI Number | 1104789379
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Entity Type | Individual
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Provider Name | SAMANTHA BLOMMEL
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Gender | Female
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3225 HILLCREST PARK DR
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City | MEDFORD
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State | OR
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Zip | 97504-7657
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Country | US
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Telephone | 541-774-5700
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Fax | 541-774-5700
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Provider Business Mailing Address
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Address Line | 3225 HILLCREST PARK DR
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City | MEDFORD
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State | OR
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Zip | 97504-7657
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Country | US
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Telephone | 541-774-5700
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Fax | 541-774-5700
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 10028973
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License Number State | OR
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