Basic Information
| Provider Information | |||||||||
| NPI: | 1902465883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROCHASKA | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | AA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4665 DOUGLAS CIR NW STE 100 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447183673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304995700 | ||||||||
| FaxNumber: | 3304984229 | ||||||||
| Practice Location | |||||||||
| Address1: | 4665 DOUGLAS CIR NW STE 100 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447183673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304995700 | ||||||||
| FaxNumber: | 3304984229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2019 | ||||||||
| LastUpdateDate: | 06/13/2019 | ||||||||
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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 | 367H00000X | 67.000348 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |
No ID Information.