1396979605 NPI number — MRS. SAMANTHA BRITTANY BARBRE LPN

Table of content: MRS. SAMANTHA BRITTANY BARBRE LPN (NPI 1396979605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396979605 NPI number — MRS. SAMANTHA BRITTANY BARBRE LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARBRE
Provider First Name:
SAMANTHA
Provider Middle Name:
BRITTANY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOLLER
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
BRITTANY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396979605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5322 CAMELOT DR
Provider Second Line Business Mailing Address:
APT A
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45014-4079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-885-3427
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5322 CAMELOT DR
Provider Second Line Business Practice Location Address:
APT A
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45014-4079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-885-3427
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  PN 131161 IV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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