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General NPI Number Information
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NPI Number | 1568013928
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Entity Type | Individual
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Provider Name | SAMANTHA WALTON FNP-BC, NP-C,
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Gender | Female
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 3010 MATTHEW LN APT C3
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City | HOMEWOOD
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State | IL
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Zip | 60430-2873
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Country | US
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Telephone | 773-416-3128
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 MATTHEW LN APT C3
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City | HOMEWOOD
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State | IL
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Zip | 60430-2873
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Country | US
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Telephone | 773-416-3128
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A182128
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 12210
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1089371
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 277001344
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 278913
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71015726A
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License Number State | IN
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