MEDICARE: SAMANTHA EVELYN DEMARCE

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
1	363LF0000X	Family Nurse Practitioner	4704315851	MI

General Provider Information

NPI Number	:	1447957816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA EVELYN DEMARCE

Provider Business Mailing Address
First Line	:	17901 HURON RIVER DR
Second Line	:
City	:	NEW BOSTON
State	:	MI
Zip	:	48164-3200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17901 HURON RIVER DR
Second Line	:
City	:	NEW BOSTON
State	:	MI
Zip	:	48164-3200
Country	:	US
Telephone Number	:	734-315-7070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/15/2023

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