Healthcare Provider Details

I. General information

NPI: 1497179063
Provider Name (Legal Business Name): SAMANTHA STEINWINDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SECURITY SQ
GULFPORT MS
39507-1932
US

IV. Provider business mailing address

400 SECURITY SQ
GULFPORT MS
39507-1932
US

V. Phone/Fax

Practice location:
  • Phone: 228-865-1330
  • Fax:
Mailing address:
  • Phone: 228-865-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR879778
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR879778
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: