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NPI Code Detail

MEDICARE: SAMANTHA QUILLEN CNP

MEDICARE: SAMANTHA QUILLEN CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner16577OH

General Provider Information

NPI Number : 1083018915
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA QUILLEN CNP
Provider Business Mailing Address
First Line : 110 DUBLIN DR
Second Line :
City : DOVER
State : OH
Zip : 44622-7805
Country : US
Telephone Number : 330-343-0753
Fax Number :
Provider Business Practice Location Address
First Line : 110 DUBLIN DR
Second Line :
City : DOVER
State : OH
Zip : 44622-7805
Country : US
Telephone Number : 330-343-0753
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2014
Last Update Date : 11/12/2020

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Directions to “ SAMANTHA QUILLEN CNP” Practice Location

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