Provider Demographics
NPI:1285748814
Name:VOLSTORF, SAMANTHA ALEXIS (FNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALEXIS
Last Name:VOLSTORF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2460
Mailing Address - Country:US
Mailing Address - Phone:217-465-4141
Mailing Address - Fax:217-463-2769
Practice Address - Street 1:721 E COURT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2460
Practice Address - Country:US
Practice Address - Phone:217-465-4141
Practice Address - Fax:217-463-2769
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002156A363LF0000X
IL209009354363LP0808X
IL209-009354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200835340Medicaid
INP00459738OtherRR MEDICARE
P00824217OtherRAILROAD
IN252060B2Medicare PIN
IN130910OOMedicare PIN
IN854700KKKKMedicare PIN
INP00459738OtherRR MEDICARE
P00824217OtherRAILROAD
IN941090W5Medicare PIN
IN254390IMedicare PIN