Healthcare Provider Details

I. General information

NPI: 1033393764
Provider Name (Legal Business Name): CYNTHIA R SAMSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 OLD STAGE RD
WEST HATFIELD MA
01088-9513
US

IV. Provider business mailing address

68 OLD STAGE RD
WEST HATFIELD MA
01088-9513
US

V. Phone/Fax

Practice location:
  • Phone: 413-247-9849
  • Fax: 413-247-5239
Mailing address:
  • Phone: 413-247-9849
  • Fax: 413-247-5239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number278714
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: