Provider Demographics
NPI:1396284949
Name:RUHBECK, SAMANTHA MARY (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARY
Last Name:RUHBECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:370 LARRY POWER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5194
Mailing Address - Country:US
Mailing Address - Phone:815-937-3515
Mailing Address - Fax:815-935-0916
Practice Address - Street 1:370 LARRY POWER RD STE 1
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-5194
Practice Address - Country:US
Practice Address - Phone:815-937-3515
Practice Address - Fax:815-935-0916
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006114363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant