MEDICARE: SAMANTHA MYERS

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	363A00000X	Physician Assistant	1226696	IL

General Provider Information

NPI Number	:	1871462697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MYERS

Provider Business Mailing Address
First Line	:	30 N BRAINARD ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-4690
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N BRAINARD ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-4690
Country	:	US
Telephone Number	:	630-637-5555
Fax Number	:

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

Provider Enumeration Date	:	10/31/2025
Last Update Date	:	10/31/2025

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Directions to “ SAMANTHA MYERS ” Practice Location

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