Provider Demographics
NPI:1912647330
Name:MCCUE, SAMANTHA ELAINE (LPN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELAINE
Last Name:MCCUE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GRINDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-4762
Mailing Address - Country:US
Mailing Address - Phone:814-977-6679
Mailing Address - Fax:
Practice Address - Street 1:9709 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-3717
Practice Address - Country:US
Practice Address - Phone:814-652-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN314157164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse