Provider Demographics
NPI:1316282361
Name:SEALE, SAMANTHA J (LPN)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:J
Last Name:SEALE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7674 WHITEPINE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8050
Mailing Address - Country:US
Mailing Address - Phone:937-269-6485
Mailing Address - Fax:
Practice Address - Street 1:7674 WHITEPINE RIDGE CT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8050
Practice Address - Country:US
Practice Address - Phone:937-269-6485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.149733-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse