Provider Demographics
NPI:1982977724
Name:BAUMAN, SAMANTHA R (ACNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3807
Mailing Address - Country:US
Mailing Address - Phone:513-783-4222
Mailing Address - Fax:513-783-4477
Practice Address - Street 1:235 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3807
Practice Address - Country:US
Practice Address - Phone:513-783-4222
Practice Address - Fax:513-783-4477
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN322855363LA2100X
OH13175NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000756093OtherANTHEM
OH0061191Medicaid
OH$$$$$$$$$00OtherBWC
OHH078350Medicare PIN