Provider Demographics
NPI:1538756440
Name:LIN, SAMANTHA DEVENEY (FNP-BC, MS, MPH)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DEVENEY
Last Name:LIN
Suffix:
Gender:F
Credentials:FNP-BC, MS, MPH
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:DEVENEY
Other - Last Name:LEEDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MPH
Mailing Address - Street 1:1525 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5512
Mailing Address - Country:US
Mailing Address - Phone:212-305-5756
Mailing Address - Fax:
Practice Address - Street 1:1525 E 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5512
Practice Address - Country:US
Practice Address - Phone:212-305-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20140044RN163W00000X
OR202011296NP-PP363LF0000X, 363LP2300X
IL209.024782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.024782Medicaid