Individual
HEATHER SAMUDOVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 E CARPENTER ST, SPRINGFIELD, IL 62769-4902
(217) 544-6464
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-007904
IL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
05/02/2020
Last updated
03/07/2024
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