Provider Demographics
NPI:1902105927
Name:PARRY, SAMANTHA JAYNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JAYNE
Last Name:PARRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:JAYNE
Other - Last Name:SHEETS-MCCREARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:6774 AMANDA SOUTHERN RD SW
Mailing Address - Street 2:
Mailing Address - City:AMANDA
Mailing Address - State:OH
Mailing Address - Zip Code:43102-9710
Mailing Address - Country:US
Mailing Address - Phone:740-407-6059
Mailing Address - Fax:
Practice Address - Street 1:6774 AMANDA SOUTHERN RD SW
Practice Address - Street 2:
Practice Address - City:AMANDA
Practice Address - State:OH
Practice Address - Zip Code:43102-9710
Practice Address - Country:US
Practice Address - Phone:740-407-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH117711164W00000X
OH346181163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse