Provider Demographics
NPI:1457145609
Name:DONNELLY, SAMANTHA LYNN
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNN
Last Name:DONNELLY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EATONDALE RD APT 203
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-5931
Mailing Address - Country:US
Mailing Address - Phone:570-972-8643
Mailing Address - Fax:
Practice Address - Street 1:100 EATONDALE RD APT 203
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-5931
Practice Address - Country:US
Practice Address - Phone:570-972-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY969819163W00000X
NC326057163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse