Provider Demographics
NPI:1992560643
Name:CHAMBERS, SAMANTHA JO (FNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:HARGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1416
Mailing Address - Country:US
Mailing Address - Phone:831-917-1043
Mailing Address - Fax:
Practice Address - Street 1:1013 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2110
Practice Address - Country:US
Practice Address - Phone:641-684-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA178267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily