Provider Demographics
NPI:1962143164
Name:HOLZHAUER, SAMANTHA CHRISTINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:CHRISTINE
Last Name:HOLZHAUER
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 1:1177 TAHOE PL
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-3658
Mailing Address - Country:US
Mailing Address - Phone:314-208-1137
Mailing Address - Fax:
Practice Address - Street 1:50 MERAMEC TRAIL DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-3303
Practice Address - Country:US
Practice Address - Phone:636-923-2396
Practice Address - Fax:636-923-2371
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017030578364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology