Provider Demographics
NPI:1225773260
Name:OUELLET, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:OUELLET
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 1:203 COMMERCE DRIVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-9723
Mailing Address - Country:US
Mailing Address - Phone:717-284-3137
Mailing Address - Fax:717-284-4164
Practice Address - Street 1:203 COMMERCE DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-9723
Practice Address - Country:US
Practice Address - Phone:717-284-3137
Practice Address - Fax:717-284-4164
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily