Provider Demographics
NPI:1285485284
Name:RUSCHAK, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:RUSCHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-9750
Mailing Address - Country:US
Mailing Address - Phone:724-972-6679
Mailing Address - Fax:
Practice Address - Street 1:AVERE BEAUTY
Practice Address - Street 2:3453 BUTLER ST
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201
Practice Address - Country:US
Practice Address - Phone:412-952-7592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily