Provider Demographics
NPI:1386272060
Name:HENTSCHKE, SAMANTHA (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HENTSCHKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2071 GOOSE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SAUGET
Mailing Address - State:IL
Mailing Address - Zip Code:62206-2822
Mailing Address - Country:US
Mailing Address - Phone:618-857-2700
Mailing Address - Fax:618-857-2699
Practice Address - Street 1:2071 GOOSE LAKE RD
Practice Address - Street 2:
Practice Address - City:SAUGET
Practice Address - State:IL
Practice Address - Zip Code:62206-2822
Practice Address - Country:US
Practice Address - Phone:618-857-2700
Practice Address - Fax:618-857-2699
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical