Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN275754 | OH |
NPI | 1003264060 |
---|---|
Provider Name | Samantha C Cole |
First Address | Mentor, OH 44060-7106 |
Second Address | Willoughby, OH 44094-9646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2016 |
Last Update Date | 01/06/2016 |