Provider Demographics
NPI:1710770276
Name:CIMINO, SAMANTHA PAIGE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PAIGE
Last Name:CIMINO
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 N WEBB WAY APT S304
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1196
Mailing Address - Country:US
Mailing Address - Phone:442-257-9170
Mailing Address - Fax:
Practice Address - Street 1:1350 N WEBB WAY APT S304
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1196
Practice Address - Country:US
Practice Address - Phone:208-918-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDL-314150163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty