Provider Demographics
NPI:1588402366
Name:WILES, SAMANTHA RACHELLE (RN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RACHELLE
Last Name:WILES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:RACHELLE
Other - Last Name:GALUSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10351 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-8613
Mailing Address - Country:US
Mailing Address - Phone:304-290-8640
Mailing Address - Fax:
Practice Address - Street 1:10351 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:WV
Practice Address - Zip Code:26542-8613
Practice Address - Country:US
Practice Address - Phone:304-290-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114872163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics