Basic Information
| Provider Information | |||||||||
| NPI: | 1659007730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDDY | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24738 S ELSIE ST | ||||||||
| Address2: | |||||||||
| City: | CHANNAHON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604105065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308771352 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604358200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157257133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2022 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.025597 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.