Provider Demographics
NPI:1922898642
Name:WHITEHEAD, SAMANTHA JULIANNA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JULIANNA
Last Name:WHITEHEAD
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 1:3430 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-9405
Mailing Address - Country:US
Mailing Address - Phone:234-267-9932
Mailing Address - Fax:
Practice Address - Street 1:3430 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-9405
Practice Address - Country:US
Practice Address - Phone:234-267-9932
Practice Address - Fax:234-267-9932
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide