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General NPI Number Information
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NPI Number | 1689027278
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Entity Type | Individual
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Provider Name | SAMANTHA DONOVAN
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Gender | Female
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 4385 MARYLAND AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2703
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Country | US
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Telephone | 504-896-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 1538 LOUISIANA AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70115-3553
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Country | US
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Telephone | 504-896-2345
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Fax | 504-896-2240
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 8079
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License Number State | MO
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