Provider Demographics
NPI:1366987919
Name:BALDESER, SAMANTHA MARIE (LPN)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:BALDESER
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 1:111 LOWENSTEIN LANE
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315
Mailing Address - Country:US
Mailing Address - Phone:614-633-7361
Mailing Address - Fax:
Practice Address - Street 1:111 LOWENSTEIN LANE
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315
Practice Address - Country:US
Practice Address - Phone:614-633-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.156653.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse