Provider Demographics
NPI:1396558243
Name:PELT, SAMATHA JEAN
Entity type:Individual
Prefix:
First Name:SAMATHA
Middle Name:JEAN
Last Name:PELT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3262 4TH AVE E APT 110
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5066
Mailing Address - Country:US
Mailing Address - Phone:970-570-5606
Mailing Address - Fax:
Practice Address - Street 1:3262 4TH AVE E APT 110
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5066
Practice Address - Country:US
Practice Address - Phone:970-570-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1396823747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant