Healthcare Provider Details

I. General information

NPI: 1174875389
Provider Name (Legal Business Name): SAMANTHA MUNSELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 VICTORIA RD
ASHEVILLE NC
28801-4811
US

IV. Provider business mailing address

PO BOX 602998
CHARLOTTE NC
28260-2998
US

V. Phone/Fax

Practice location:
  • Phone: 828-252-7331
  • Fax: 828-253-1123
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-06673
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: