Basic Information
| Provider Information | |||||||||
| NPI: | 1982977724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUMAN | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 N BREIEL BLVD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450423807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137834222 | ||||||||
| FaxNumber: | 5137834477 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 N BREIEL BLVD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450423807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137834222 | ||||||||
| FaxNumber: | 5137834477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2012 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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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 | 363LA2100X | RN322855 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | 13175NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 000000756093 | 01 | OH | ANTHEM | OTHER | 0061191 | 05 | OH | MEDICAID |