Provider Demographics
NPI:1366160343
Name:LOUDEN, SAMANTHA JENINE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JENINE
Last Name:LOUDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3664
Mailing Address - Country:US
Mailing Address - Phone:301-268-9435
Mailing Address - Fax:
Practice Address - Street 1:410 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3664
Practice Address - Country:US
Practice Address - Phone:301-268-9435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD102729667753747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty