Healthcare Provider Details

I. General information

NPI: 1487489324
Provider Name (Legal Business Name): SAMANTHA ANDRADA MURO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6947 E LOMITA AVE
MESA AZ
85209-6604
US

IV. Provider business mailing address

6947 E LOMITA AVE
MESA AZ
85209-6604
US

V. Phone/Fax

Practice location:
  • Phone: 480-318-1937
  • Fax:
Mailing address:
  • Phone: 480-318-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number259268
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: