MEDICARE: VERNICE MAE SAMUELS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	319082	NY

General Provider Information

NPI Number	:	1093996563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNICE MAE SAMUELS

Provider Business Mailing Address
First Line	:	13503 218TH ST
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11413-1933
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21441 JAMAICA AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1733
Country	:	US
Telephone Number	:	718-217-4111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	07/21/2022

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Directions to “ VERNICE MAE SAMUELS ” Practice Location

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