Healthcare Provider Details

I. General information

NPI: 1457074783
Provider Name (Legal Business Name): CHRISTINA MARIE SAMARITONI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26136 HIGHWAY 59
FAIRFAX MO
64446-2295
US

IV. Provider business mailing address

26136 HIGHWAY 59
FAIRFAX MO
64446-2295
US

V. Phone/Fax

Practice location:
  • Phone: 660-686-2368
  • Fax:
Mailing address:
  • Phone: 660-686-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2020006013
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number53-81806-121
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2022049299
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: