Provider Demographics
NPI:1588557656
Name:TODD, SAMANTHA RAE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAE
Last Name:TODD
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 1:4018 N 126TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1960
Mailing Address - Country:US
Mailing Address - Phone:531-242-9699
Mailing Address - Fax:
Practice Address - Street 1:2510 N CLARKSON ST APT 1206
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2341
Practice Address - Country:US
Practice Address - Phone:402-919-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator