MEDICARE: SAMANTHA NOLTE

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1700687605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA NOLTE

Provider Business Mailing Address
First Line	:	827 FALCON ST APT 135
Second Line	:
City	:	PARK HILLS
State	:	MO
Zip	:	63601-7813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 CHILDREN'S LANE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23507-9982
Country	:	US
Telephone Number	:	757-668-7249
Fax Number	:

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

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	05/14/2025

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Directions to “ SAMANTHA NOLTE ” Practice Location

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