Basic Information
| Provider Information | |||||||||
| NPI: | 1306400031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VON BAUER | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 533 BARKER ST | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440901107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196513850 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6140 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440533821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402337232 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2019 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.436013 | OH | Y | Nursing Service Providers | Registered Nurse |
No ID Information.