Healthcare Provider Details

I. General information

NPI: 1780018804
Provider Name (Legal Business Name): SAMANTHA VALCOURT RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 QUARRY RD SUITE 102
PALO ALTO CA
94304-1416
US

IV. Provider business mailing address

211 QUARRY RD SUITE 102
PALO ALTO CA
94304-1416
US

V. Phone/Fax

Practice location:
  • Phone: 650-724-1800
  • Fax: 650-736-2550
Mailing address:
  • Phone: 650-724-1800
  • Fax: 650-736-2550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number647530
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number3826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: